David - I said this wrong in the first answer. What I should have said was a single node does not put you into stage four. If you read the staging outline you will see that other things besides nodes can bump you into stage 4, along with multiple nodes. Some people have a huge primary and that alone is enough to do it. As the staging page says, this is only to determine possible guidelines (which are only a base line recommendation) of treatments, and a means for doctors to describe you to each other in a simple way.


Stage 4 - Any of the following may be true: The cancer has spread to tissues around the lip and oral cavity. The lymph nodes in the area may or may not contain cancer. The cancer is any size and has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimeters (over 2 inches). The cancer has spread to other parts of the body.

You can see how generalized this is, (cancer has spread to tissues around the oral cavity--- how much spread, how invasive this is WAY generalized) and therefore far from a definitive description of what actually is the situation. TNM was developed as a better means to classify patients. Please also remember that this is not a universally accepted system, and is very general by nature. The TNM system is much more finite and used more when specifics are required.