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Additional info for AJCC Cancer Staging Manual
Sagittal view of the face and neck depicting the subdivisions of the pharynx as described in the text. and the arytenoid and cricoid cartilages. The posterior pharyngeal wall extends from the level of the superior surface of the hyoid bone (or floor of the vallecula) to the inferior border of the cricoid cartilage and from the apex of one pyriform sinus to the other. Regional Lymph Nodes. The risk of regional nodal spread from cancers of the pharynx is high. Primary nasopharyngeal tumors commonly spread to retropharyngeal, upper jugular, and spinal accessory nodes, often bilaterally.
The scale, in lO-point increments from 0 (dead) to 100 (normal, no complaints, no evidence of disease), was devised in 1948 by David A. Karnofsky. The KPS is a reliable, independent predictor of survival outcome for patients with solid tumors, so it is a required baseline assessment in clinical protocols in head and neck and other cancers. The AJCC strongly recommends recording of KPS along with standard staging information. Karno/sky Scale: Criteria 0/ Performance Status (PS) 100 Normal; no complaints; no evidence of disease 90 Able to carry on normal activity; minor signs or symptoms of disease 80 Able to carry on normal activity with effort; some signs or symptoms of disease 70 Cares for self; unable to carry on normal activity or do active work 60 Requires occasional assistance but is able to care for most of own needs 50 Requires considerable assistance and frequent medical care 40 Disabled; requires special care and assistance Diagnosis and treatment of depression mayaiso aid in symptom control and improved quality of life.
2). Note that this would include caudal portions of Levels IV and V. All cases with lymph no des (whoIe or part) in the fossa are considered N3b. VB Any T Stage IVe Any T NO NO NO NI NI NI NO NI N2 N2 N2 NO NI 2 NO NI N2 N3 Any N MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MO MI Distant Metastasis (M) Distant metastasis cannot be assessed No distant metastasis Distant metastasis MX MO MI ~ \\\\ PJ ! / ~! emalend of Clavicle FIG. 2. Shaded triangular area corresponds to the supraclavicular fossa used in staging carcinoma of the nasopharynx.