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Head and Neck Cancer Staging

Head and neck cancer staging tells you how widespread or advanced the cancer is. Determining the stage helps doctors explain the extent of the cancer to you. It also helps them determine how to move forward with treatment, including surgery, radiation therapy, or chemotherapy.

Your doctor will assign a stage to the cancer after your physical exam and the initial results from your other diagnostic tests and imaging. The stage may be adjusted if you have additional tests or after surgery. There are five stages of head and neck cancer, starting at zero and going up to four. (They are represented by the Roman numerals I, II, III, and IV.)

These are the basic stages of head and neck cancer:

Stage 0 Head and Neck Cancer

Also called carcinoma in situ, this is the very beginning of the scale. It describes abnormal cells in the lining of the affected area that have the potential to become cancer.

Stage I Head and Neck Cancer

Stage I describes a very early stage of cancer. The tumor is not more than two centimeters. The cancer has not reached the lymph nodes.

Stage II Head and Neck Cancer

Stage II describes a tumor that is larger than two centimeters but not more than four centimeters. Stage II cancer has not reached the lymph nodes.

Stage III Head and Neck Cancer

Stage III head and neck cancer describes cancer that either is larger than four centimeters or has spread to a lymph node on the same side of the neck as the tumor and the lymph node is smaller than three centimeters.

Stage IV Head and Neck Cancer

Stage IV is the most advanced stage of head and neck cancer. The tumor may be any size, but it has spread to:

  • nearby tissue or other areas of the head and neck
  • one large lymph node (more than three centimeters in size) and on the same side of the neck as the tumor, multiple lymph nodes of any size on the same side of the neck as the tumor, or one lymph node of any size on the side of the neck opposite the tumor
  • distant parts of the body beyond the head and neck, such as the lungs

Head and neck cancer may be stage IV when it is first diagnosed. Stage IV head and neck cancer can also be recurrent head and neck cancer. Recurrent means the cancer has come back after treatment. The cancer may come back in the part of the body where it originally developed (regional recurrence), in the lymph nodes (regional relapse), or in another part of the body (distant recurrence).

Stage III and stage IV head and neck cancers are more likely to recur than earlier-stage cancers.

Staging for HPV-Positive Head and Neck Cancer

Head and neck experts have developed a separate staging system for HPV-positive cancer. This approach reflects the fact that HPV-positive tumors have a better prognosis than HPV-negative ones.

Learn more about treatment options for people with HPV-positive head and neck cancer.