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Oral cancers can spread via the lymphatic system into the neck and later to distant lymphatic sites as well as to other organs such as the lung.

Staging is the process used by doctors to determine how far the cancer has spread. Staging plays an important role in both planning treatment as well as predicting the chances of recovery (prognosis).

The most common staging system used to describe the extent of oral and tongue cancer is known as the TNM system. This system describes three key pieces of information about the cancer:

• T = Tumor Size - refers to the size of the primary tumor

• N = Lymph Node involvement - describes the extent of spread of the cancer to nearby lymph nodes. Cancer cells from oral cavity or oropharyngeal cancer can enter lymph nodes in the neck area

• M = Metastasis - indicates whether the cancer has spread (metastasized) to other organs in the body

Additional letters or numbers appear after T, N, and M to provide specific details about each of these factors. After staging, the TNM scores are added together to classify patients into one of the following staging groups:

• Stage I - The size of the tumor is less than 2 centimeters (cm). The cancer has not spread clinically beyond the primary site of the tumor

• Stage II - The size of the tumor is between greater than 2 cm but less than 4 cm. The cancer has not spread clinically beyond the primary site of the tumor

• Stage III - The size of the tumor is 2 cm or larger and some lymph node involvement may be present.

• Stage IVA - The tumor may be any size and there is definite lymph node involvement. Either multiple lymph nodes are involved or a single lymph node measuring between 3 to 6 cm.

• Stage IVB - The tumor may be any size but there is definite lymph node involvement. The size of the lymph nodes is greater than 6 cm.

• Stage IVC - Oral or tongue cancer that has spread to distant organs.