Stages of Nasopharyngeal Cancer

Cancer stage describes the extent of cancer in the body.

Cancer stage describes the extent of cancer in the body, such as the size of the tumor, whether it has spread, and how far it has spread from where it first formed. Knowing the cancer stage helps plan treatment. 

There are several staging systems for cancer that describe the extent of the cancer. Nasopharyngeal cancer staging usually uses the TNM staging system. You may see the cancer described by this staging system in your pathology report. Based on the TNM results, a stage (I, II, III, or IV, also written as 1, 2, 3, or 4) is assigned to the cancer. When talking to you about your diagnosis, your doctor may describe the cancer as one of these stages.

Learn more about Cancer Staging. 

The following stages are used for nasopharyngeal cancer:

Stage 0 (also called carcinoma in situ of the nasopharynx)

In stage 0, abnormal cells are found in the lining of the nasopharynx. These abnormal cells may become cancer and spread into nearby normal tissue.

Stage I (also called stage 1) nasopharyngeal cancer

In stage I, cancer has formed, and the cancer:

• is found in the nasopharynx only; or
• has spread from the nasopharynx to the oropharynx and/or to the nasal cavity.

Stage II (also called stage 2) nasopharyngeal cancer

In stage II, one of the following is true:

• Cancer has spread to one or more lymph nodes on one side of the neck and/or to one or more lymph nodes on one or both sides of the back of the throat. The affected lymph nodes are 6 centimeters or smaller. Cancer is found:
  • in the nasopharynx only or has spread from the nasopharynx to the oropharynx and/or to the nasal cavity; or
  • only in the lymph nodes in the neck. The cancer cells in the lymph nodes are infected with Epstein-Barr virus (a virus linked to nasopharyngeal cancer).
• Cancer has spread to the parapharyngeal space and/or nearby muscles. Cancer may have also spread to one or more lymph nodes on one side of the neck and/or to one or more lymph nodes on one or both sides of the back of the throat. The affected lymph nodes are 6 centimeters or smaller.

Stage III (also called stage 3) nasopharyngeal cancer

In stage III, one of the following is true:

• Cancer has spread to one or more lymph nodes on both sides of the neck. The affected lymph nodes are 6 centimeters or smaller. Cancer is found:
  • in the nasopharynx only or has spread from the nasopharynx to the oropharynx and/or to the nasal cavity; or
  • only in the lymph nodes in the neck. The cancer cells in the lymph nodes are infected with Epstein-Barr virus (a virus linked to nasopharyngeal cancer).
• Cancer has spread to the parapharyngeal space and/or nearby muscles. Cancer has also spread to one or more lymph nodes on both sides of the neck. The affected lymph nodes are 6 centimeters or smaller.
• Cancer has spread to the bones at the bottom of the skull, the bones in the neck, jaw muscles, and/or the sinuses around the nose and eyes. Cancer may have also spread to one or more lymph nodes on one or both sides of the neck and/or the back of the throat. The affected lymph nodes are 6 centimeters or smaller.

Stage IV (also called stage 4) nasopharyngeal cancer

Stage IV is divided into stages IVA and IVB.

• In stage IVA:
  • Cancer has spread to the brain, the cranial nerves, the hypopharynx, the salivary gland in the front of the ear, the bone around the eye, and/or the soft tissues of the jaw. Cancer may have also spread to one or more lymph nodes on one or both sides of the neck and/or the back of the throat. The affected lymph nodes are 6 centimeters or smaller; or
  • Cancer has spread to one or more lymph nodes on one or both sides of the neck. The affected lymph nodes are larger than 6 centimeters and/or are found in the lowest part of the neck.
• In stage IVB: Cancer has spread beyond the lymph nodes in the neck to distant lymph nodes, such as those between the lungs, below the collarbone, or in the armpit or groin, or to other parts of the body, such as the lung, bone, or liver.

Stage IV nasopharyngeal cancer is also called metastatic nasopharyngeal cancer. Metastatic cancer happens when cancer cells travel through the lymphatic system or blood and form tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if nasopharyngeal cancer spreads to the lung, the cancer cells in the lung are actually nasopharyngeal cancer cells. The disease is called metastatic nasopharyngeal cancer, not lung cancer. Learn more in Metastatic Cancer: When Cancer Spreads.

Nasopharyngeal cancer can recur (come back) after it has been treated.

Recurrent nasopharyngeal cancer is cancer that has come back after it has been treated. If nasopharyngeal cancer comes back, it may come back in the nasopharynx, lymph nodes, or other parts of the body, such as the lungs, bone, or liver. Tests will help determine where in the body the cancer has returned. The type of treatment that you have for recurrent nasopharyngeal cancer will depend on where it has come back.

Learn more in Recurrent Cancer: When Cancer Comes Back. Information to help you cope and talk with your health care team can be found in the booklet When Cancer Returns.