Skip to main content
SpringerLink
Log in

Staging of Nasopharyngeal Carcinoma

  • Chapter
Nasopharyngeal Cancer

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

In oncology, “to stage ” a patient implies two intentions. The first uses clinical examination and investigations to describe the extent of disease to permit a rational treatment strategy to be formulated. The second employs an agreed classification system to categorize extent of disease within risk hierarchies that predict outcome following conventional treatment strategies. For the latter, the foremost priority is given to the risk of death and is provided by the joint TNM classification of the International Union Against Cancer (UICC) and the American Joint Committee on Cancer (AJCC), a discussion about which will comprise the majority of this chapter. In the creation of the TNM, a strong emphasis is paid to ensure that the classification is both useful for clinicians and researchers, while also being applicable in regions of the world where nasopharyngeal carcinoma (NPC) has its highest incidence. These goals may engender conflict between the latest scientific discoveries and practical application in jurisdictions, where such advances are difficult to implement. This is particularly relevant to NPC and often some compromise is needed to permit all stakeholders to embrace an international classification.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Au JS, Law CK, Foo W, et al (2003) In-depth evaluation of the AJCC/UICC 1997 staging system of nasopharyngeal carcinoma: prognostic homogeneity and proposed refinements. Int J Radiat Oncol Biol Phys 56:413–426

    Article  PubMed  Google Scholar 

  • Casanova M, Ferrari A, Gandola L, et al (2001) Undifferentiated nasopharyngeal carcinoma in children and adolescents: comparison between staging systems. Ann Oncol 12: 1157–1162

    Article  CAS  PubMed  Google Scholar 

  • Chan KC, Lo YM (2002) Circulating EBV DNA as a tumor marker for nasopharyngeal carcinoma. Semin Cancer Biol 12:489–496

    Article  CAS  PubMed  Google Scholar 

  • Chan SC, Chang JT, Wang HM, et al (2009) Prediction for distant failure in patients with stage M0 nasopharyngeal carcinoma: the role of standardized uptake value. Oral Oncol 45:52–58

    Article  PubMed  Google Scholar 

  • Cheng SH, Tsai SY, Yen KL, et al (2005) Prognostic significance of parapharyngeal space venous plexus and marrow involvement: potential landmarks of dissemination for stage I–III nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 61:456–465

    Article  PubMed  Google Scholar 

  • Chong VF, Ong CK (2008) Nasopharyngeal carcinoma. Eur J Radiol 66:437–447

    Article  CAS  PubMed  Google Scholar 

  • Chua DT, Sham JS, Kwong DL, et al (1996) Prognostic value of paranasopharyngeal extension of nasopharyngeal carcinoma. A significant factor in local control and distant metastasis. Cancer 78:202–210

    CAS  Google Scholar 

  • Chua DT, Sham JS, Wei WI, et al (2001) The predictive value of the 1997 American Joint Committee on Cancer stage classification in determining failure patterns in nasopharyngeal carcinoma. Cancer 92:2845–2855

    Article  CAS  PubMed  Google Scholar 

  • Chua ML, Ong SC, Wee JT, et al (2009) Comparison of 4 modalities for distant metastasis staging in endemic nasopharyngeal carcinoma. Head Neck 31:346–354

    Article  PubMed  Google Scholar 

  • Cooper JS, Cohen R, Stevens RE (1998) A comparison of staging systems for nasopharyngeal carcinoma. Cancer 83: 213–219

    Article  CAS  PubMed  Google Scholar 

  • Corry J, Fisher R, Rischin D, et al (2004) Clinical verification of the superiority of the current International Union Against Cancer staging criteria in an Australian population of patients with nasopharyngeal carcinoma. Australas Radiol 48:509–515

    Article  CAS  PubMed  Google Scholar 

  • Dubrulle F, Souillard R, Hermans R (2007) Extension patterns of nasopharyngeal carcinoma. Eur Radiol 17:2622–2630

    Article  CAS  PubMed  Google Scholar 

  • Feng AC, Wu MC, Tsai SY, et al (2006) Prevertebral muscle involvement in nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 65:1026–1035

    Article  PubMed  Google Scholar 

  • Fleming I, Cooper J, Henson D, Hutter R, Kennedy B, Murphy G, O'Sullivan B, Yarbo J, Sobin L (eds) (1997) AJCC cancer staging manual, 5th edn. Lippincott-Raven, Philadelphia

    Google Scholar 

  • Gospodarowicz MK, Miller D, Groome PA, et al (2004) The process for continuous improvement of the TNM classification. Cancer 100:1–5

    Article  PubMed  Google Scholar 

  • Greene FL, Page D, Norrow M, Balch C, Haller D, Fritz A, Fleming ID (eds) (2002) AJCC cancer staging manual, 6th edn. Springer, New York

    Google Scholar 

  • Harnsberger HR (1995) The masticator space. In: Harnsberger HR (ed) Handbook of head and neck imaging, 2nd edn. Mosby, St. Louis, pp 46–59

    Google Scholar 

  • Heng DM, Wee J, Fong KW, et al (1999) Prognostic factors in 677 patients in Singapore with nondisseminated nasopharyngeal carcinoma. Cancer 86:1912–1920

    Article  CAS  PubMed  Google Scholar 

  • Ho J (1978a) An epidemiologic and clinical study of nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 4:183–198

    Article  Google Scholar 

  • Ho J (1978b) Stage classification of nasopharyngeal carcinoma: a review in nasopharyngeal carcinoma, etiology and control. IARC Sci Publ 20:99–113

    PubMed  Google Scholar 

  • Hong MH, Mai HQ, Min HQ, et al (2000) A comparison of the Chinese 1992 and fifth-edition International Union Against Cancer staging systems for staging nasopharyngeal carcinoma. Cancer 89:242–247

    Article  CAS  PubMed  Google Scholar 

  • Johns M, Neal D, Cantrell R (1984) Staging of cervical lymph node metastasis: comparison of two systems. Ann Otol Rhinol Laryngol 93:330–332

    CAS  PubMed  Google Scholar 

  • Kalogera-Fountzila A, Karanikolas D, Katodritis N, et al (2006) Prognostic factors and significance of the revised 6th edition of the AJCC classification in patients with locally advanced nasopharyngeal carcinoma. Strahlenther Onkol 182:458–466

    Article  PubMed  Google Scholar 

  • King AD, Te o P, Lam WW, et al (2000) Paranasopharyngeal space involvement in nasopharyngeal cancer: detection by CT and MRI. Clin Oncol (R Coll Radiol) 12:397–402

    CAS  Google Scholar 

  • King AD, Zee B, Yuen EH, et al (2007) Nasopharyngeal cancers: which method should be used to measure these irregularly shaped tumors on cross-sectional imaging? Int J Radiat Oncol Biol Phys 69:148–154

    Article  PubMed  Google Scholar 

  • Lee AW, Au JS, Teo PM, et al (2004) Staging of nasopharyngeal carcinoma: suggestions for improving the current UICC/ AJCC Staging System. Clin Oncol (R Coll Radiol) 16: 269–276

    CAS  Google Scholar 

  • Lee AW, Foo W, Law CK, et al (1996a) N-staging of nasopharyngeal carcinoma: discrepancy between UICC/AJCC and Ho systems. Clin Oncol (R Coll Radiol) 8:155–159

    CAS  Google Scholar 

  • Lee AW, Foo W, Law SC, et al (1999) Staging of nasopharyngeal carcinoma: from Ho's to the new UICC system. Int J Cancer 84:179–187

    Article  CAS  PubMed  Google Scholar 

  • Lee AW, Foo W, Poon YF, et al (1996b) Staging of nasopharyngeal carcinoma: evaluation of N-staging by Ho and UICC/ AJCC systems. Clin Oncol (R Coll Radiol) 8:146–154

    CAS  Google Scholar 

  • Lee CC, Chu ST, Chou P, et al (2008) The prognostic influence of prevertebral space involvement in nasopharyngeal carcinoma. Clin Otolaryngol 33:442–449

    Article  PubMed  Google Scholar 

  • Lee CC, Ho HC, Su YC, et al (2009) Bidimensional measurement of nasopharyngeal carcinoma: a simple method to predict outcomes. Clin Otolaryngol 34:26–33

    Article  PubMed  Google Scholar 

  • Leung SF, Zee B, Ma BB, et al (2006) Plasma Epstein—Barr viral deoxyribonucleic acid quantitation complements tumor-node-metastasis staging prognostication in nasopharyngeal carcinoma. J Clin Oncol 24:5414–5418

    Article  CAS  PubMed  Google Scholar 

  • Liao XB, Mao Y P, Liu LZ, et al (2008) How does magnetic resonance imaging influence staging according to AJCC staging system for nasopharyngeal carcinoma compared with computed tomography? Int J Radiat Oncol Biol Phys 72:1368–1377

    Article  PubMed  Google Scholar 

  • Liu L, Liang S, Li L, et al (2009) Prognostic impact of magnetic resonance imaging-detected cranial nerve involvement in nasopharyngeal carcinoma. Cancer 115:1995–2003

    Article  PubMed  Google Scholar 

  • Liu MZ, Tang LL, Zong JF, et al (2008) Evaluation of sixth edition of AJCC staging system for nasopharyngeal carcinoma and proposed improvement. Int J Radiat Oncol Biol Phys 70:1115–1123

    Article  PubMed  Google Scholar 

  • Lo YM (2001) Prognostic implication of pretreatment plasma/ serum concentration of Epstein-Barr virus DNA in nasopharyngeal carcinoma. Biomed Pharmacother 55: 362–365

    Article  CAS  PubMed  Google Scholar 

  • Low JS, Heng DM, Wee JT (2004) The question of T2a and N3a in the UICC/AJCC (1997) staging system for nasopharyn-geal carcinoma. Clin Oncol (R Coll Radiol) 16:581–583

    CAS  Google Scholar 

  • Ma J, Mai HQ, Hong MH, et al (2001) Is the 1997 AJCC staging system for nasopharyngeal carcinoma prognostically useful for Chinese patient populations? Int J Radiat Oncol Biol Phys 50:1181–1189

    Article  CAS  PubMed  Google Scholar 

  • Mafee MF (2005) Nasopharynx. In: Mafee MF, Valvassori GE, Becker M (eds) Imaging of the head and neck, 2nd edn. Thieme, Stuttgart, pp 555–578

    Google Scholar 

  • Mao Y P, Liang SB, Liu LZ, et al (2008) The N staging system in nasopharyngeal carcinoma with radiation therapy oncology group guidelines for lymph node levels based on magnetic resonance imaging. Clin Cancer Res 14:7497–7503

    Article  CAS  PubMed  Google Scholar 

  • Min H, Hong M, Ma J, et al (1994) A new staging system for nasopharyngeal carcinoma in China. Int J Radiat Oncol Biol Phys 30:1037–1042

    CAS  PubMed  Google Scholar 

  • NCCN (2009) National comprehensive cancer network — head and neck. http://www.nccn.org/professionals/physician_ gls/PDF/head-and-neck.pdf. Accessed 1 Jun 2009

  • Neel HB, Taylor WF (1989) New staging system for nasopha-ryngeal carcinoma. Long-term outcome. Arch Otolaryngol Head Neck Surg 115:1293–1303

    Google Scholar 

  • Ng SH, Chan SC, Ye n TC, et al (2009) Staging of untreated nasopharyngeal carcinoma with PET/CT: comparison with conventional imaging work-up. Eur J Nucl Med Mol Imaging 36:12–22

    Article  PubMed  Google Scholar 

  • Ng WT, Chan SH, Lee AW, et al (2008) Parapharyngeal extension of nasopharyngeal carcinoma: still a significant factor in era of modern radiotherapy? Int J Radiat Oncol Biol Phys 72:1082–1089

    Article  PubMed  Google Scholar 

  • Ng WT, Lee AW, Kan WK, et al (2007) N-staging by magnetic resonance imaging for patients with nasopharyngeal carcinoma: pattern of nodal involvement by radiological levels. Radiother Oncol 82:70–75

    Article  PubMed  Google Scholar 

  • Nishioka T, Shirato H, Kagei K, et al (2000) Skull-base invasion of nasopharyngeal carcinoma: magnetic resonance imaging findings and therapeutic implications. Int J Radiat Oncol Biol Phys 47:395–400

    Article  CAS  PubMed  Google Scholar 

  • Ozyar E, Yildiz F, Akyol FH, et al (1999) Comparison of AJCC 1988 and 1997 classifications for nasopharyngeal carcinoma. American Joint Committee on Cancer. Int J Radiat Oncol Biol Phys 44:1079–1087

    CAS  Google Scholar 

  • Pan WR, Suami H, Corlett RJ, et al (2009) Lymphatic drainage of the nasal fossae and nasopharynx: preliminary anatomical and radiological study with clinical implications. Head Neck 31:52–57

    Article  PubMed  Google Scholar 

  • Roh JL, Sung MW, Kim KH, et al (2004) Nasopharyngeal carcinoma with skull base invasion: a necessity of staging subdivision. Am J Otolaryngol 25:26–32

    Article  PubMed  Google Scholar 

  • Sakata K, Hareyama M, Tamakawa M, et al (1999) Prognostic factors of nasopharynx tumors investigated by MR imaging and the value of MR imaging in the newly published TNM staging. Int J Radiat Oncol Biol Phys 43:273–278

    Article  CAS  PubMed  Google Scholar 

  • Sham JS, Choy D (1991) Prognostic value of paranasopharyn-geal extension of nasopharyngeal carcinoma on local control and short-term survival. Head Neck 13:298–310

    Article  CAS  PubMed  Google Scholar 

  • Sham JS, Choy D, Choi PH (1990) Nasopharyngeal carcinoma: the significance of neck node involvement in relation to the pattern of distant failure. Br J Radiol 63:108–113

    Article  CAS  PubMed  Google Scholar 

  • Sham JS, Wei WI, Nicholls J, et al (1992) Extent of nasopharyn-geal carcinoma involvement inside the nasopharynx. Lack of prognostic value on local control. Cancer 69:854–859

    Article  CAS  PubMed  Google Scholar 

  • Sobin LH, Wittekind C (eds) (1997) TNM classification of malignant tumors, 5th edn. Wiley, New York

    Google Scholar 

  • Sobin LH, Wittekind C (eds) (2002) TNM classification of malignant tumors, 6th edn. Wiley, New York

    Google Scholar 

  • Som PM, Curtin HD (2003) Fascia and spaces of the neck. In: Som PM, Curtin HD (eds) Head and neck imaging, 4th edn. Mosby, St Louis, pp 1805–1827

    Google Scholar 

  • Tang L, Li L, Mao Y, et al (2008) Retropharyngeal lymph node metastasis in nasopharyngeal carcinoma detected by magnetic resonance imaging: prognostic value and staging categories. Cancer 113:347–354

    Article  PubMed  Google Scholar 

  • Teo P, Lee WY, Yu P (1996a) The prognostic significance of parapharyngeal tumour involvement in nasopharyngeal carcinoma. Radiother Oncol 39:209–221

    Article  CAS  PubMed  Google Scholar 

  • Te o P, Leung SF, Yu P, et al (1991a) A retrospective comparison between different stage classifications for nasopharyngeal carcinoma. Br J Radiol 64:901–908

    Article  CAS  PubMed  Google Scholar 

  • Te o P, Yu P, Lee WY, et al (1996b) Significant prognosticators after primary radiotherapy in 903 nondisseminated nasopharyn-geal carcinoma evaluated by computer tomography. Int J Radiat Oncol Biol Phys 36:291–304

    CAS  PubMed  Google Scholar 

  • Te o PM, Leung SF, Yu P, et al (1991b) A comparison of Ho's, International Union Against Cancer, and American Joint Committee stage classifications for nasopharyngeal carcinoma. Cancer 67:434–439

    Article  CAS  PubMed  Google Scholar 

  • Tham IW, Hee SW, Yap SP, et al (2009) Retropharyngeal nodal metastasis related to higher rate of distant metastasis in patients with N0 and N1 nasopharyngeal cancer. Head Neck 31:468–474

    Article  PubMed  Google Scholar 

  • Tsao S (1993) A new working staging system for nasopharyn-geal carcinoma (NPC). In: Tursz T, Pagano J, Ablashi D, de The G, Lenoir G, Pearson G (eds) The Epstein—Barr virus and associated diseases, vol 225. John Libby Eurotext, Paris, pp 727–734

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G, 2M9, Canada

    Brian O'Sullivan

  2. Department of Medical Imaging, Princess Margaret Hospital, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada

    Eugene Yu

Authors
  1. Brian O'Sullivan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eugene Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Radiation Oncology, National University Cancer Institute of Singapore National University Health System National University of Singapore, 5 Lower Kent Ridge Road, Singapore, 119074, Republic of Singapore

    J. J. Lu (Associate Professor and Consultant, Distinguished Clinical Professor) (Associate Professor and Consultant, Distinguished Clinical Professor)

  2. Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200232, P.R. China

    J. J. Lu (Associate Professor and Consultant, Distinguished Clinical Professor) (Associate Professor and Consultant, Distinguished Clinical Professor)

  3. Department of Radiation Oncology, Maimonides Cancer Center, 6300 Eighth Avenue, Brooklyn, NY, 11220, USA

    J. S. Cooper (Professor and Chairman) (Professor and Chairman)

  4. Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong SAR, P.R. China

    A. W. M. Lee

Rights and permissions

Reprints and permissions

Copyright information

© 2010 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

O'Sullivan, B., Yu, E. (2010). Staging of Nasopharyngeal Carcinoma. In: Lu, J.J., Cooper, J.S., Lee, A.W.M. (eds) Nasopharyngeal Cancer. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-92810-2_24

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-92810-2_24

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-92809-6

  • Online ISBN: 978-3-540-92810-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation