Stages of Lip and Oral Cavity 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. Lip and oral cavity cancer staging usually uses the TNM staging system. The cancer may be 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 lip and oral cavity cancer:

Stage 0 (carcinoma in situ)

In stage 0, abnormal cells are found in the lining of the lips and oral cavity. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I (also called stage 1) lip and oral cavity cancer

In stage I, cancer has formed. The tumor is 2 centimeters or smaller and the deepest point of tumor invasion is 5 millimeters or less.

Stage II (also called stage 2) lip and oral cavity cancer

In stage II, the tumor:

• is 2 centimeters or smaller and the deepest point of tumor invasion is greater than 5 millimeters; or
• is larger than 2 centimeters but not larger than 4 centimeters and the deepest point of tumor invasion is 10 millimeters or less.

Stage III (also called stage 3) lip and oral cavity cancer

In stage III, the tumor:

• is larger than 2 centimeters but not larger than 4 centimeters and the deepest point of tumor invasion is greater than 10 millimeters; or
• is larger than 4 centimeters and the deepest point of tumor invasion is 10 millimeters or less; or
• has spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the primary tumor.

Stage IV (also called stage 4) lip and oral cavity cancer

Stage IV is divided into stages IVA, IVB, and IVC.

• In stage IVA, the tumor:
  • is larger than 4 centimeters and the deepest point of tumor invasion is greater than 10 millimeters; or has spread to the outer surface of the upper or lower jawbone, into the maxillary sinus, or to the skin of the face. The cancer may have spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the primary tumor; or
  • is any size or cancer has spread to the outer surface of the upper or lower jawbone, into the maxillary sinus, or to the skin of the face. Cancer has spread:
    • to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the primary tumor, and cancer has spread through the outside covering of the lymph node into nearby connective tissue; or
    • to one lymph node that is larger than 3 centimeters but not larger than 6 centimeters, on the same side of the neck as the primary tumor; or
    • to multiple lymph nodes that are not larger than 6 centimeters, on the same side of the neck as the primary tumor; or
    • to multiple lymph nodes that are not larger than 6 centimeters, on the opposite side of the neck as the primary tumor or on both sides of the neck.
• In stage IVB, the tumor:
  • has spread to one lymph node that is larger than 6 centimeters; or
  • has spread to one lymph node that is larger than 3 centimeters, on the same side of the neck as the primary tumor, and cancer has spread through the outside covering of the lymph node into nearby connective tissue; or
  • has spread to one lymph node of any size on the opposite side of the neck as the primary tumor, and cancer has spread through the outside covering of the lymph node into nearby connective tissue; or
  • has spread to multiple lymph nodes anywhere in the neck, and cancer has spread through the outside covering of any lymph node into nearby connective tissue; or
  • has spread further into the muscles or bones needed for chewing, or to the part of the sphenoid bone behind the upper jaw, and/or to the carotid artery near the base of the skull. Cancer may have also spread to one or more lymph nodes of any size, anywhere in the neck.
• In stage IVC, the tumor:
  • has spread beyond the lip or oral cavity to other parts of the body, such as the lung, liver, or bone.

    Stage IVC lip and oral cavity cancer is also called metastatic lip and oral cavity 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 lip and oral cavity cancer spreads to the lung, the cancer cells in the lung are actually lip and oral cavity cancer cells. The disease is called metastatic lip and oral cavity cancer, not lung cancer. Learn more in Metastatic Cancer: When Cancer Spreads.

Lip and oral cavity cancer can recur (come back) after it has been treated.

Recurrent lip and oral cavity cancer is cancer that has come back after it has been treated. If lip and oral cavity cancer comes back, it may come back in the lip, mouth, or other parts of the body. Tests will help determine where in the body the cancer has returned. The type of treatment that you have for recurrent lip and oral cavity 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.