TNM 9THAJCC Nasopharynx Staging Framework

Clinical Category

Assign AJCC Stage Group

The 9th Edition

The AJCC 9th Edition for nasopharynx refined the N-category staging and emphasized the prognostic value of plasma EBV DNA. Patients with high post-treatment EBV DNA levels have a significantly higher risk of recurrence regardless of stage.

Therapeutic Outlook

Stage II

Clinical Strategy

Locally advanced disease. Induction chemotherapy followed by concurrent chemoradiotherapy is often favored.

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

Clinical Use

Staging of all nasopharyngeal carcinoma cases.

Initial workup must include EBV DNA (plasma), Nasopharyngoscopy, and MRI of the skull base/neck.

Used to determine the intensity of induction chemotherapy and the volume of radiotherapy.

How it Works

N (Regional Nodes) Updates

N1: Unilateral metastasis, above the caudal border of the cricoid cartilage.

N2: Bilateral metastasis, above the caudal border of the cricoid cartilage.

N3: Metastasis extending below the caudal border of the cricoid cartilage.

Stage Grouping

Stage	Definition	Management
Stage I	T1 N0	Radiotherapy alone.
Stage II-III	Locally advanced	Concurrent Chemoradiation (Cisplatin + RT).
Stage IVA	Advanced Locoregional	Induction Chemotherapy followed by Chemoradiation.

Last Comprehensive Review: 2026

TNM 9THAJCC Nasopharynx Staging Framework

Clinical Category

Assign AJCC Stage Group

The 9th Edition

Therapeutic Outlook

Stage II

Clinical Strategy

Locally advanced disease. Induction chemotherapy followed by concurrent chemoradiotherapy is often favored.

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

Clinical Use

Staging of all nasopharyngeal carcinoma cases.

Initial workup must include EBV DNA (plasma), Nasopharyngoscopy, and MRI of the skull base/neck.

Used to determine the intensity of induction chemotherapy and the volume of radiotherapy.

How it Works

N (Regional Nodes) Updates

N1: Unilateral metastasis, above the caudal border of the cricoid cartilage.

N2: Bilateral metastasis, above the caudal border of the cricoid cartilage.

N3: Metastasis extending below the caudal border of the cricoid cartilage.

Stage Grouping

Stage	Definition	Management
Stage I	T1 N0	Radiotherapy alone.
Stage II-III	Locally advanced	Concurrent Chemoradiation (Cisplatin + RT).
Stage IVA	Advanced Locoregional	Induction Chemotherapy followed by Chemoradiation.

Last Comprehensive Review: 2026

TNM 9th (Nasopharynx)

Clinical Category

Stage II

When to Use

Clinical Use

How it Works

N (Regional Nodes) Updates

Stage Grouping

Clinical Pearls

The EBV DNA Biomarker

Radiotherapy Sensitivity

The Evidence

Key Reference

Proposals for the 9th Edition TNM Staging System for Nasopharyngeal Carcinoma

Related Tools

Recent Journal Updates

TNM 9th (Nasopharynx)

Clinical Category

Stage II

When to Use

Clinical Use

How it Works

N (Regional Nodes) Updates

Stage Grouping

Clinical Pearls

The EBV DNA Biomarker

Radiotherapy Sensitivity

The Evidence

Key Reference

Proposals for the 9th Edition TNM Staging System for Nasopharyngeal Carcinoma

Related Tools

Recent Journal Updates