Oral cancer stages describe the condition’s severity, whether the cancer has spread, and how far. The higher the number or letter of the stage, the more the cancer has progressed.

Cancer staging helps doctors determine the most appropriate type of treatment, as well as indicate survival statistics.

There are two categories of oropharyngeal cancer: P16-positive, which contains human papillomavirus (HPV) DNA, and p16-negative.

They each have their own staging system because p16-positive cancers have a better outlook than p16-negative. Oropharyngeal cancer is a type of head and neck cancer.

This article looks at oral cancer staging, as well as recurrent oral cancer, how quickly oral cancer spreads, and which stages are curable.

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The staging system that most doctors use is the TNM system from the American Joint Committee on Cancer (AJCC).

The AJCC’s TNM system stages cancer using three criteria: tumor (T), lymph nodes (N), and metastasis (M).

Numbers and letters that appear after T, N, and M provide more detail and comprise the stage grouping. This allows clinicians to determine the cancer’s overall stage.

Learn more about cancer staging and the TNM system here.

Also known as carcinoma in situ, this cancer stage may have no symptoms.

Cancer cells are limited to the endothelium (a thin membrane that lines the inside of blood vessels) and have not spread to nearby tissue.

The following table looks at the TNM staging for stage 0 p16-negative oral cancer.

LetterStaging Description
TTis, or carcinoma in situ Cancer cells are present in the epithelium, the top layer of cells that line the oral cavity and throat. They have not spread into deeper tissue layers.
NN0Cancer has not spread to nearby nodes.
MM0Cancer has not spread to distant sites.

Stage 0 is curable, and people at risk of this type of cancer can benefit from screening to allow for early detection. Oral cancer risk factors include smoking and regular alcohol use.

Stage 1 cancer still has not spread to distant areas of the body but may be in a nearby lymph node for p16-positive cancer.

The table below shows the TNM staging for stage 1 p16-negative oral cancer.

TT1Cancer has not spread, and the tumor is 2 centimeters (cm) or smaller.
NN0Cancer has not spread to nearby nodes.
MM0Cancer has not spread to distant sites.

The table below shows the TNM staging for stage 1 p16-positive oral cancer.

LetterStaging Description
TT0, T1, or T2T0: There is no evidence that a primary tumor exists.
T1: Tumor is 2 cm or smaller and has not spread.
T2: Tumor is 2–4cm and has not spread.
NN0 or N1N0: Cancer has not spread to nearby lymph nodes.
N1: Cancer has spread from the primary site to a single node on the same side of the neck as the initial tumor. The node is 3 cm or smaller, and there is no growth outside of the node.
MM0Cancer has not spread to distant sites.

Early symptoms may include mouth pain or a sore throat.

If a person has symptoms that persist, they should contact a doctor.

Learn more about the early warning signs of oral cancer here.

The TNM staging for stage 2 p16-negative oral cancer is as below.

Letter Stage

At this stage, p16-positive cancer can present in two different ways. One way is as follows.

TT0, T1, or T2
NN2, or the cancer has spread to one or more lymph nodes.

Another way p16-positive cancer can present is as below.

TT3: Tumor is larger than 4 cm, or has spread to the base of the tongue.
T4: Tumor has spread to a nearby structure, such as the tongue, hard palate, or jaw.
NN0 or N1

People living with stage 2 oral cancer may notice tissue changes such as lumps, red or white patches in their mouth or persistent mouth sores that don’t heal.

Learn more about what oral cancer looks like here.

There are two ways that doctors categorize p16-negative oral cancer in stage 3.

Letter p16-negative Ap16-negative Bp16-positive
TT3T1, T2, or T3T3 or T4

As cancer spreads to nearby tissues, it may cause symptoms such as:

At stage 4, cancer has spread to distant areas of the body.

Letter p16-positive
TAny T
NAny N
MM1, or has spread to distant organs

The symptoms a person experiences depends on where the cancer has spread.

For example, cancer that has spread to the lungs can cause symptoms such as chest pain, coughing, and shortness of breath.


This stage is known as moderately advanced local disease. P16-negative cancer can present in more than one way.

Letterp16-negative Ap16-negative B
TT4aT1, T2, T3, or T4a
NN0 or N1N2

In stage T4a, the tumor may be any size and grows into nearby structures.

Where the cancer spreads depends on the primary cancer location.

  • Lip cancers: Cancer may have spread to nearby bone, the jawbone nerve, the skin of the nose or chin, or the floor of the mouth.
  • Oral cavity cancers: Cancer may have spread to the jaw or facial bones, tongue muscle, facial skin, or the maxillary sinus (the hollow spaces on either side of the nose).
  • Oropharyngeal cancers: Cancer may have spread to the larynx, the hard palate, the jaw, the tongue muscle, or surrounding bones.


Stage 4b can also appear in two ways for p16-negative oral cancer:

Letterp16-negative Ap16-negative B
TAny TT4b, the most advanced T stage. Cancer has spread to nearby structures such as bones or the base of the skull. The tumor can be any size and may surround the carotid artery.
NN3, wherein cancer has spread outside the lymph nodes Any N

Because stage 4b cancer has not spread to distant body parts, experts refer to it as a very advanced local disease.


At this stage, cancer has spread to distant areas. The primary tumor can be any size and may or may not have spread to nearby structures or lymph nodes.

TAny T
NAny N

Also known as relapsed cancer, recurrent cancer is cancer that has returned after treatment. The recurrence can be:

  • local — in the throat or mouth
  • regional — in the lymph nodes nearby
  • distant — in another area of the body, such as the lungs

Recurrent cancer is not in the TNM staging.

Oral cancer stages relate to the size of the tumor, whether it has spread, and how far. Staging helps doctors plan treatments and predict outcomes.

There are two types of oral cancer: P16-negative and p16-positive. The outlook for each type is different, so doctors use separate staging systems when assessing these cancers.

Oral cancer is curable in its early stages but may not have clear symptoms. People who regularly smoke tobacco and use alcohol are at higher risk of this cancer and may benefit from screening.