Primary tumor cannot be assessed

No evidence of primary tumor

Carcinoma in situ

Tumor ≤ 2 cm in largest extension

Tumor > 2 cm to ≤ 4 cm in largest extension

Tumor > 4 cm in largest extension or superficial bone invasion or perineural invasion or deep invasion

Tumor with macroscopic bone invasion/bone marrow invasion

Tumor with invasion of the axial skeleton including foramen and/or involvement of vertebral foramen to epidural space

Regional lymph nodes cannot be assessed

No regional lymph node metastasis

Metastasis in a regional lymph node, ≤ 3 cm in largest extension

Regional lymph node metastasis

Metastasis in solitary ipsilateral lymph node, > 3 cm to ≤ 6 cm in largest extension, without extranodal extension

Metastasis in multiple ipsilateral lymph nodes, all up to max. ≤ 6 cm in largest extension, without extranodal extension

Metastasis in bilateral or contralateral lymph nodes, all up to max. ≤ 6 cm in largest extension, without extranodal extension

Metastasis in lymph nodes, > 6 cm in largest extension, without extranodal extension

Metastasis in solitary or multiple lymph nodes, clinically with extranodal extension

No distant metastasis

Distant metastasis (including bilateral or contralateral lymph node metastasis)