Oral cancer

You are here: 

Stages of oral cancer

Staging describes or classifies a cancer based on how much cancer there is in the body and where it is when first diagnosed. This is often called the extent of cancer. Information from tests is used to find out the size of the tumour, which parts of the organ have cancer, whether the cancer has spread from where it first started and where the cancer has spread. Your healthcare team uses the stage to plan treatment and estimate the outcome (your prognosis).

The most common staging system for oral cancer is the TNM system. For oral cancer there are 5 stages – stage 0 followed by stages 1 to 4. Often the stages 1 to 4 are written as the Roman numerals I, II, III and IV. Generally, the higher the stage number, the more the cancer has spread. Talk to your doctor if you have questions about staging.

When describing the stage, doctors may use the words local, regional or distant. Local means that the cancer is only in the mouth and has not spread to other parts of the body. Regional means the cancer has spread to the lymph nodes in the neck (cervical lymph nodes). Distant means in a part of the body farther from the mouth.

Find out more about staging cancer.

Stage 0 (or carcinoma in situ)

The cancer is only in the lining of the mouth or lips.

Stage 1

The tumour is 2 cm or smaller.

Stage 2

The tumour is larger than 2 cm but no more than 4 cm.

Stage 3

The tumour is larger than 4 cm or the cancer has spread to one lymph node in the neck on the same side as the tumour and the lymph node is 3 cm or smaller.

Stage 4A

The tumour is any size and has grown into any of the following:

  • the bone in the palate or lower jaw
  • a nerve in the lower jaw called the inferior alveolar nerve
  • floor of the mouth
  • skin of the face

The cancer may also have spread to 1 or more lymph nodes in the neck, and they are 6 cm or smaller.

Stage 4B

The tumour has grown into the soft tissues of the cheek such as muscles, nerves or blood vessels, or into the base of the skull, or the tumour is wrapped around the internal carotid artery of the neck.


The cancer has spread to lymph nodes in the neck and one is larger than 6 cm or the cancer in a lymph node has grown into the surrounding tissue.

Stage 4C

The cancer has spread to other parts of the body (called distant metastasis), such as to the lungs, liver or bone. This is also called metastatic oral cancer.

Recurrent oral cancer

Recurrent oral cancer means that the cancer has come back after it has been treated. If it comes back in the same place that the cancer first started, it’s called local recurrence. If it comes back in tissues or lymph nodes close to where it first started, it’s called regional recurrence. It can also recur in another part of the body. This is called distant metastasis or distant recurrence.


Dr Connie Eaves Tracking how stem cells grow

How can you stop cancer before it starts?

It's My Life! icon

Discover how 16 factors affect your cancer risk and how you can take action with our interactive tool – It’s My Life! Presented in partnership with Desjardins.

Learn more