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T — Primary tumour 1,2
Note: Superficial erosion alone of bone/tooth socket by gingival primary is not sufficient to classify a tumour as T4.
N - Regional Lymph Nodes##
Note: Midline nodes are considered ipsilateral nodes.
M - Distant metastasis
Stage grouping
## The regional lymph nodes are the cervical nodes.
1 Adpated from Edge et al.
2 A help desk for specific questions about the TNM classification is available at https://www.uicc.org/resources/tnm/helpdesk.
TNM classification of carcinomas of the lip and oral cavity
T — Primary tumour 1,2
| TX | Primary tumour cannot be assessed |
| T0 | No evidence of primary tumour |
| Tis | Carcinoma in situ |
| T1 | Tumour 2 cm or less in greatest dimension |
| T2 | Tumour more than 2 cm but not more than 4 cm in greatest dimension |
| T3 | Tumour more than 4 cm in greatest dimension |
| T4a (lip) | Tumour invades through cortical bone, inferior alveolar nerve, floor of mouth, or skin (chin or nose) |
| T4a (oral cavity) | Tumour invades through cortical bone, into deep/extrinsic muscle of tongue (genioglossus, hyoglossus, palatoglossus, and styloglossus), maxillary sinus, or skin of face |
| T4b (lip and oral cavity) | Tumour invades masticator space, pterygoid plates, or skull base; or encases internal carotid artery |
Note: Superficial erosion alone of bone/tooth socket by gingival primary is not sufficient to classify a tumour as T4.
N - Regional Lymph Nodes##
| NX | Regional lymph nodes cannot be assessed |
| N0 | No regional lymph node metastasis |
| N1 | Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension |
| N2 | Metastasis as specified in N2a, 2b, 2c below |
| N2a | Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension |
| N2b | Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension |
| N2c | Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension |
| N3 | Metastasis in a lymph node more than 6 cm in greatest dimension |
Note: Midline nodes are considered ipsilateral nodes.
M - Distant metastasis
| M0 | No distant metastasis |
| M1 | Distant metastasis |
Stage grouping
| Stage 0 | Tis | N0 | M0 |
| Stage I | T1 | N0 | M0 |
| Stage II | T2 | N0 | M0 |
| Stage III | T1, T2 | N1 | M0 |
| T3 | N0, N1 | M0 | |
| Stage IVA | T1, T2, T3 | N2 | M0 |
| T4a | N0, N1, N2 | M0 | |
| Stage IVB | Any T | N3 | M0 |
| T4b | Any N | M0 | |
| Stage IVC | Any T | Any N | M1 |
## The regional lymph nodes are the cervical nodes.
1 Adpated from Edge et al.
2 A help desk for specific questions about the TNM classification is available at https://www.uicc.org/resources/tnm/helpdesk.
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