TNM Staging Guide 5th Edition eBook

N2b* Metastasis in multiple ipsilateral lymph nodes, none more that 6 cm in greatest dimension, ENE(-) N2c* Metastasis in bilateral or contralateral lymph node(s), none more than 6 cm in greatest dimension, ENE(-) N3a* Metastasis in a lymph node more than 6 cm in greatest dimension N3b* Metastasis in a lymph node larger than 3cm with ENE(+) or multiple ipsilateral, bilateral or contralateral lymph nodes with evidence of ENE(+)** *Note: A designation of “U” or “L” may be used for any N stage to indicate metastasis above the lower border of the cricoid cartilage (U) or below the lower border of the cricoid cartilage (L). **ENE is pathologically classified as ENEmi (microscopic ENE ≤ 2mm) or ENEma (macroscopic ENE>2mm). Both ENEmi and ENEma qualify as ENE(+) for the purposes of pN Staging. NECK STAGING FOR HPV-MEDIATED OROPHARYNGEAL CANCER For HPV-mediated Oropharyngeal Cancer, there is a clinical and pathologic nodal staging system CLINICAL REGIONAL LYMPH NODE STAGING (CN), HPV-MEDIATED OROPHARYNGEAL CANCER cNX Regional lymph nodes cannot be assessed cN0 No regional nodes metastasis cN1* One or more ipsilateral lymph node metastases ≤ 6 cm

cN2* Contralateral or bilateral lymph node(s) ≤ 6cm cN3* Any neck lymph node metastasis larger than 6cm

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