Regarding NPC staging, which criterion places a patient in Stage IVA (AJCC 8th edition)?

• A Involvement of retropharyngeal lymph nodes ≤6 cm
• B Any T with contralateral N2 nodes
• C T3 tumour with ipsilateral cervical lymph node ≤3 cm
• D T4 primary tumour (infiltrating intracranial structures, cranial nerve involvement, hypopharynx, orbit, or parotid) ✓

Explanation

In the AJCC 8th edition for NPC: Stage IVA is defined as T4 disease (tumour infiltrating intracranial structures, cranial nerves, hypopharynx, orbit, or parotid gland beyond the capsule) with N0–N2 and M0. Stage IVB is any T with N3 (nodal metastasis >6 cm or extending below the caudal border of cricoid cartilage) and M0. Stage IVC is any T, any N, M1. The T4 criterion reflects extensive local spread beyond the nasopharynx, requiring chemoradiation with concurrent cisplatin.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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