Stage IV HPV-negative oropharyngeal cancer

Stage IV is divided into stages IVA, IVB, and IVC. In stage IVA, cancer (1) has spread to the larynx (voice box), front part of the roof of the mouth, lower jaw, or muscles that move the tongue. Cancer may have spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the primary tumor; or (2) is any size and may have spread to the top of the epiglottis, larynx, front part of the roof of the mouth, lower jaw, or muscles that move the tongue. Cancer has spread to one of the following: (a) one lymph node that is larger than 3 centimeters but not larger than 6 centimeters, on the same side of the neck as the primary tumor; or (b) more than one lymph node that is 6 centimeters or smaller, anywhere in the neck. In stage IVB, cancer (1) has spread to the muscle that moves the lower jaw, the bone attached to the muscle that moves the lower jaw, the base of the skull, or to the area behind the nose or around the carotid artery. Cancer may have spread to lymph nodes in the neck; or (2) may be any size and may have spread to other parts of the head or neck. Cancer has spread to a lymph node that is larger than 6 centimeters or has spread through the outside covering of a lymph node into nearby connective tissue. In stage IVC, cancer has spread to other parts of the body, such as the lung, liver, or bone.

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