CT scan with contrast of the neck from the skull base to the superior mediastinum is the best initial film and may show bony invasion or cervical metastasis. MRI can be used to evaluate tissue planes, airway lesions, or intracranial spread. Chest x-ray is mandatory for screeing for pulmonary metastasis. Staging

Oropharynx T1 < 2 cm; T2 2-4 cm; T3 > 4 cm; T4 invades adjacent structure

Nasopharynx T1 one subsite; T2 >1 subsite; T3 invades nasal cavity; T4 invades skull

Hypopharynx T1 one site; T2 >1 site + nl larynx; T3 >1 site + fixed larynx;

T4 invades adjacent structure Supraglottis T1 1 site + nl larynx; T2 >1 site + nl larynx; T3 limited to larynx with fixed larynx or adjacent extension; T4 invasion Glottis T1 limited to vocal cords, nl fxn; T2 extends above/below or abnl vocal cord fixation T3 vocal cord fixation T4 invasion

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