Type, Grade & Stage

Stage

The stage of a cancer is determined by the TNM staging system:

  • The ‘T’ stands for tumor size.
  • The ‘N’ stands for lymph node involvement.
  • The ‘M’ stands for distant metastases, or cancer spread to other areas of the body.

The TNM staging of different cancers of the orbit are as follows:

  • Staging of Lacrimal Gland Carcinoma
  • Staging of Orbital Sarcoma
  • Staging of Ocular Adnexal Lymphoma
  • Staging of Eyelid Carcinoma

Staging helps doctors determine how serious the cancer is and how best to treat it. Staging systems often reference very specific anatomical structures. Please reference the anatomy page to learn more about these terms.

Staging is generally based on the American Joint Committee on Cancer (AJCC) 8th edition guidelines. Currently, the 8th edition of the AJCC does not have a formal staging system for lacrimal gland carcinoma, orbital sarcoma, or ocular adnexal lymphoma, due to a lack of data. TNM definitions can be found here, but no formal stages are defined. 

Lacrimal Gland Carcinoma
T Definition
TXThe primary tumor cannot be evaluated.
T0There is no evidence of a primary tumor.
T1The tumor is 2 centimeters or less, whether or not it has extended into the orbital soft tissue outside of the gland.T1a – No periosteal (thin membrane covering the orbital bone) or bone involvementT1b – Periosteal involvement only T1c – Periosteal and bone involvement
T2The size of the tumor is between 2 and 4 centimeters.T2a – No periosteal (thin membrane covering the orbital bone) or bone involvementT2b – Periosteal involvement only T2c – Periosteal and bone involvement
T3The tumor is more than 4 centimeters at its largest dimension.T3a – No periosteal (thin membrane covering the orbital bone) or bone involvementT3b – Periosteal involvement only T3c – Periosteal and bone involvement
T4Cancer is involving regional areas such as the sinuses, temporal fossa, pterygoid fossa, superior orbital fissure, cavernous sinus, or brain.T4a – The tumor is 2 centimeters or less.T4b – The size of the tumor is between 2 and 4 centimeters.T4c – The tumor is more than 4 centimeters at its largest dimension.
NDefinition
NXThe neck lymph nodes cannot be assessed.
N0There is no evidence of any spread to the lymph nodes.
N1 There is spread to lymph nodes in the region.
MDefinition
M0No evidence of distant (outside the head and neck) spread.
M1There is evidence of spread outside of the head and neck (i.e., in the lungs, bone, brain, etc.).
Orbital Sarcoma
T Definition
TXThe primary tumor cannot be evaluated.
T0There is no evidence of a primary tumor.
T1The tumor is 2 centimeters or less.
T2The size of the tumor is larger than 2 centimeters without invasion into bony walls or globe.
T3Tumor of any size with invasion into bony walls.
T4Tumor of any size with invasion into globe or periorbital structures (i.e. eyelid, sinuses, and/or brain, etc.). 
NDefinition
NXThe neck lymph nodes cannot be assessed.
N0There is no evidence of any spread to the lymph nodes.
N1 There is spread to lymph nodes in the region.
MDefinition
M0No evidence of distant (outside the head and neck) spread.
M1There is evidence of spread outside of the head and neck (i.e., in the lungs, bone, brain, etc.).
Ocular Adnexal Lymphoma
T Definition
TXLymphoma spread not specified. 
T0No evidence of lymphoma.
T1Lymphoma involves the conjunctiva only without the eyelid or orbit.
T2Lymphoma involves the orbit only with or without the conjunctiva.
T3Lymphoma with preseptal eyelid involvement with or without the orbit and/or conjunctiva. 
T4Orbital adnexal lymphoma and extraorbital lymphoma spreading beyond orbit to nearby structures such as bone, sinuses, and brain. 
NDefinition
NXThe neck lymph nodes cannot be assessed.
N0There is no evidence of any spread to the lymph nodes.
N1 There is spread to lymph nodes in the region on the same side as the primary tumor. This includes nodes in the preauricular area, parotid gland, submandibular area and the side of the neck.N1a – There is spread to a single lymph node region above the mediastinum.N1b – There is spread to two or more lymph node regions above the mediastinum.
N2There is spread to lymph nodes in the regions of the mediastinum.
N3Diffuse and disseminated involvement of peripheral and central lymph node regions. 
MDefinition
M0No evidence of spread to other extranodal sites. 
M1aCancer spread is not adjoining to other tissues or organs outside of the ocular adnexa (i.e. parotid gland, submandibular gland, lung, liver, spleen, kidney, or breast).  
M1bLymphoma spreading to bone marrow.
M1cBoth M1a and M1b involvement. 
Eyelid Carcinoma
T Definition
TXThe primary tumor cannot be evaluated.
T0There is no evidence of a primary tumor.
Tis The cancer is in situ, meaning it has not invaded into deeper layers.
T1The tumor thickness is 10 millimeters or less.T1a – Tumor does not invade the tarsal plate or eyelid margin. T1b – Tumor does invade the tarsal plate or eyelid margin.T1c – Tumor involves full thickness of the eyelid. 
T2The tumor thickness is between 10 millimeters and 20 millimeters.T2a – Tumor does not invade the tarsal plate or eyelid margin. T2b – Tumor does invade the tarsal plate or eyelid margin.T2c – Tumor involves full thickness of the eyelid. 
T3The tumor thickness is between 20 millimeters and 30 millimeters.T3a – Tumor does not invade the tarsal plate or eyelid margin. T3b – Tumor does invade the tarsal plate or eyelid margin.T3c – Tumor involves full thickness of the eyelid. 
T4Any eyelid tumor that invades nearby structures such as the orbit or face.T4a – Tumor invades orbit or within the orbit. T4b – Tumor invades (or wears away) the bony walls of the orbit or spreads to the sinuses or spreads to the lacrimal sac/nasolacrimal duct or brain. 
NDefinition
NXThe neck lymph nodes cannot be assessed.
N0No evidence of lymph node involvement. 
N1 Cancer spread to a single lymph node on the same side as the primary tumor that is 3 centimeters or less. N1a – Cancer spread to a single lymph node on the same side as the primary tumor that was found on clinical examination or imaging. N1b – Cancer spread to a single lymph node on the same side as the primary tumor that was found on biopsy. 
N2Cancer spread to a single lymph node on the same side as the primary tumor that is larger than 3 centimeters or if the lymph node is on the opposite side of the primary tumor or if there are cancerous lymph nodes on the same and the opposite side of the primary tumor. N2a – Cancer spread that was found on clinical examination or imaging. N2b – Cancer spread that was found on biopsy. 
MDefinition
M0No evidence of distant spread.
M1Distant spread of disease.

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