Lip cancer staging allows doctors to determine how far the cancer has spread so that they can make decisions about a person’s treatment. There are five stages, ranging from 0–4.

When a doctor gives someone a diagnosis of lip cancer, they assess the progression of the cancer and categorize it into a stage based on the size of the tumor, whether it affects lymph nodes, and whether cancer is present elsewhere in the body.

Keep reading to learn more about lip cancer staging and the symptoms for each stage.

Close-up of a man's mouth in black-and-white.Share on Pinterest
Vera Atchou/Getty Images

Doctors use a system known as TMN staging to determine the stage of lip cancer. These letters stand for:

  • Tumor: This involves checking the size and extent of the tumor and which tissues on the lips or inside the mouth it affects.
  • Nodes: This involves checking whether the cancer has spread to nearby lymph nodes. If they have, doctors also look at how many nodes have cancer cells and how large they are.
  • Metastasis: This is when cancer spreads to another part of the body.

A doctor assesses these factors via examinations and tests. They then assign a number from 0–4 to each letter to show the cancer’s progression. The stages are:

0The cancer is in the upper layer of tissue and has not spread elsewhere.
1The cancer is smaller than 2 centimeters (cm) and has not spread elsewhere.
2The cancer is between 2 and 4 cm and has not spread elsewhere.
3The cancer is larger than 4 cm but has not spread elsewhere, or the cancer is any size and has spread to one lymph node on the same side as the tumor. The node is smaller than 3 cm.
4AThe cancer is any size and growing into nearby tissues, such as nearby bones, nerves, the mouth’s floor, the chin, or the nose. It has not spread to distant organs.

The cancer may have spread to nearby lymph nodes, either on the same side or opposite of the tumor.
4BThe cancer is any size, may have grown into nearby tissue, and has spread to at least one nearby lymph node on the same or opposite side of the head.

Or the cancer is growing into nearby structures, such as the skull base or around the carotid artery, with or without spreading to lymph nodes.
4CThe cancer is any size and has spread to distant parts of the body, such as the lungs.

Stage 0 lip cancer is known as carcinoma in situ. It means there are cancerous cells in the upper layers of the lips or inside the mouth that could grow into deeper tissues or elsewhere without treatment.

A person with cancer at this stage may not experience symptoms. One symptom of early stage lip cancer is red or white patches on the lips.

To treat it, a doctor may remove all the cancerous cells during a biopsy, or the individual may undergo a Mohs micrographic surgery. This involves a surgeon removing the top layers of tissue and a margin of healthy tissue. This procedure has a high cure rate.

In stage 1 lip cancer, there is a primary tumor below 2 cm in size that has not spread elsewhere. The tumor may look like a red sore for those with light skin or a dark brown or gray sore for those with darker skin tones.

At this stage, the individual may experience some symptoms of the cancer. The most common symptom of mouth cancer is pain or discomfort in the area that does not go away.

Other symptoms include:

  • an ulcer or area of broken skin that does not heal
  • a lump on the lip
  • thickened skin on the lip
  • unexplained bleeding or numbness on the lip
  • challenges speaking or eating

Treatment at this stage typically involves surgery unless a person cannot have surgery for medical reasons. A doctor may also recommend internal or external radiation therapy.

At stage 2, the cancer may be larger, between 2 and 4 cm in size, and may have grown deeper into the lip. This may mean the individual may experience more symptoms.

Treatment options for stage 2 also include surgical removal and radiation therapy. In some cases, a doctor may use chemotherapy alongside radiation. This is known as chemoradiation.

When a surgeon removes the cancer, they may also need to reconstruct the lips afterward. This can restore their appearance and ensure a person can chew and drink as usual.

At stage 3, cancer may have spread to nearby lymph nodes. This means that the individual may have swelling in their neck or near the jaw.

Doctors may recommend surgery and radiation therapy to treat stage 3 lip cancer. This could include removing the affected lymph nodes. Other possible treatments include the following clinical trials:

  • chemotherapy
  • chemoradiation
  • hyperfractionated radiation therapy

At stages 3 and 4, cancer is more likely to recur, meaning that the cancer may come back after treatment.

At stage 4, lip cancer may be growing into the surrounding tissues. This means the individual may have pain and swelling in areas such as the jaw or other parts of the mouth.

In late stage lip cancer, the cancer may also spread to other organs in the body. Depending on where this is, a person may also have many other symptoms. For example, lung cancer may affect breathing, and brain cancer may affect mood, mobility, or bodily functions.

This stage has the same treatment options as stage 3.

Lip cancer staging tells doctors how advanced the cancer is and helps them recommend treatments. The earlier the stage, the better the outlook.

There are five stages in total, which doctors determine using the TNM system. This considers the size and extent of the tumor, whether it affects lymph nodes, and whether it has spread elsewhere.

Surgery and radiation therapy are treatment options for lip cancer. In some cases, a doctor may also suggest chemotherapy or a clinical trial.