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Chapter 41. TNM Classification in Otolaryngology—Head and Neck Surgery

A 65-year-old patient with hoarseness is noted to have a 1-cm lesion on the left vocal cord, extending toward the anterior commissure. The vocal cord is mobile and no neck masses are noted on examination or imaging. A computed tomography (CT) chest is unremarkable. Biopsy reveals squamous cell carcinoma. Which answer best describes the TNM staging?

A. T1aN0M0

B. T1bN0M0

C. T2N0M0

D. TXN0M0

E. Unable to determine based on the information provided

A 70-year-old former smoker presented with hoarseness and dysphagia for 3 months. Laryngoscopy shows a tumor of the right false vocal cord extending to true vocal cord and medial wall of pyriform sinus on the same side. The vocal cord is mobile and there is no contralateral spread. CT neck reveals a right larynx mass with extension into the paraglottic space and a 1.8-cm lymph node on the right at level III. Biopsy confirms squamous cell carcinoma. Chest and brain imaging are negative. Which answer best describes the TNM staging?

A. T1N0M0

B. T1N1M0

C. T2N1M0

D. T2N2M0

E. T3N1M0

A 49-year-old woman is evaluated for a left-sided thyroid mass. On ultrasound, it measures 16 mm × 14 mm and no enlarged lymph nodes are identified. A chest x-ray (CXR) is negative and needle aspiration confirms papillary thyroid cancer. Which answer best describes the TNM staging?

A. T1aN0M0

B. T1bN0M0

C. T2N0M0

D. T3N0M0

E. T4N0M0

A 75-year-old smoker is seen for an ulcerative mass of the right oral tongue and floor of mouth. It measures 3.5 cm in greatest diameter and invades through cortical bone of the mandible. There are multiple right-only cervical lymph nodes, the largest of which is 2 cm. A positron emission tomography (PET) scan shows no evidence of distant disease. A biopsy shows squamous cell carcinoma. Which answer best describes the TNM staging?

A. T3N1M0

B. T3N2aM0

C. T3N2bM0

D. T4aN2aM0

E. T4aN2bM0

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