About staging and grading head and neck cancer

The stage of a cancer describes its size and whether it has spread from where it started. Knowing the stage helps doctors decide on the best treatment for you.

The staging is slightly different for each type of head and neck cancer. Your doctor or nurse can tell you more about the stage of your cancer.

The most commonly used staging systems for head and neck cancers are the TNM and number staging system.

TNM staging system

  • T describes the size of the tumour. It is numbered between 0 and 4 depending on the size and extent of the tumour.
  • T0 means that there are no signs of a tumour, but there may be abnormal cells that are pre-cancerous.
  • T1 means  a tumour is small and has not spread.
  • T4 is when a tumour has spread into nearby muscles, bones or skin.
  • N describes whether the cancer has spread to the lymph nodes.
  • N0 means that no lymph nodes are affected.
  • N1, N2 or N3 means there are cancer cells in the lymph nodes. The number depends on how many lymph nodes contain cancer cells, the size and where they are.
  • M describes whether the cancer has spread to another part of the body. This is called metastatic cancer.
  • M0 means the cancer has not spread.
  • M1 means the cancer has spread to distant organs, such as the liver or lungs.

Number staging system

There are usually 3 or 4 number stages for each cancer type. Stage 1 describes a cancer at an early stage when it is usually small in size and has not spread. Stage 4 describes a cancer at a more advanced stage when it has usually spread to other parts of the body.

Your doctor can tell you more about the stage of your cancer.

Other terms used

Your doctor may use other terms to describe the stage of the cancer:

  • Early or local – a small cancer that has not spread.
  • Locally advanced – cancer that has started to spread into surrounding tissues or nearby lymph nodes, or both.
  • Local recurrence – cancer that has come back in the same area after treatment.
  • Secondary, advanced, widespread or metastatic – cancer that has spread to other parts of the body.

Grading of head and neck cancer

The grade of a cancer gives the doctors an idea of how quickly it may develop. Doctors will look at a sample of the cancer cells under a microscope to find the grade of the cancer.

  • Grade 1 or low grade – the cancer cells look like normal cells and usually grow slowly.
  • Grade 2 and 3 – the cancer cells look different to normal cells and are slightly faster growing.
  • Grade 4 or high grade – the cancer cells look very different to normal cells and may grow more quickly.

About our information

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Chris Alcock, Consultant Clinical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.