Head & Neck Cancer
Staging & Prognosis of Head & Neck Cancer
Head neck cancers have a complex staging system which is used to predict the survival rate after treatment for head and neck cancer.
The cancer survival rates vary depending on the sites where the cancer has developed. Oral cancer is usually treated by surgery and radiotherapy, oropharyngeal cancer (throat cancer) is usually treated with radiation and chemotherapy. Laryngeal cancer and hypopharyngeal cancer is treated with radiotherapy at early stages and with surgery and radiotherapy used in advanced stages. For the most advanced squamous cell carcinoma of the head and neck and cancers of the nasopharynx combinations of chemotherapy and radiotherapy are usually used.
Survival statistics for head neck cancer also depend on the extent of tumour spread and the location of the cancer cells. This is described using the staging systems. Survival outcomes for cancer treatment can be based upon the stage as well as risk factors and other influencers of cancer mortality.
The TNM staging system (8th Edition) is most frequently used to describe the stage of head and neck cancers. T (stands for Tumour) is categorised 1-4 based mainly in size. N (stands for lymph Node) is categorised 1-3 based on size and extent of lymph node spread. M (stands of metastases) whether present or absent.
- T1 < 2 cm
- T2 > 2 to 4 cm
- T3 > 4 cm
- T4 Tumour involves adjacent structures ; T4a Operable disease; T4b Inoperable disease
- N0 No lymphadenopathy
- N1 Ipsilateral single node < 3 cm
- N2 (a) Ipsilateral single node > 3 to 6 cm; (b) Ipsilateral multiple nodes < 6 cm; (c) Bilateral or contralateral nodes < 6 cm
- N3 Nodes > 6 cm
The TNM eighth edition proposed more complex staging systems for mouth cancer (including tongue cancer and other types of oral cavity cancer), human papilloma virus related pharynx cancer, and salivary gland cancer which has a low cancer incidence.
Cancer survival statistics for head and neck cancer patients (hnc patients)depends on the extent of spread as above. For small (T1) tumours of favourable site such as larynx, overall survival rates can approach 95%. For larger tumours and those with lymph node spread, median survival rates of 60-70% are anticipated.
For very advanced tumours or those with extensive spread, the survival rates may be very poor with cure rates below 30%. It is important to discuss these issues with your cancer specialist who can give you estimates of success rates based on the medical research literature.
For almost all patients undergoing cancer care for head neck cancer, side effects of treatment are a major issue. Treatment of throat cancer and other head neck sites has a high risk of affecting critical structures involved in speech and swallowing. These occur both during the treatments and also can persist in the long-term. Specialist forms of surgery and state-of-the-art radiotherapy treatments such as intensity modulated radiotherapy (IMRT, VMAT and proton therapy have been shown in clinical trials to improve eating and swallowing after treatment as well as speech, taste, and oral health.
