Stages of head and neck cancer

The staging of the tumour. Before a treatment option is decided upon, the doctor will stage the cancer according a TNM system: the ‘T’ refers to the stage of the primary tumour and can be between 1 and 4 for all sites. It is not necessary for the reader to be conversant with the exact staging but relevant to know that T1 is an early primary tumour that would be expected to be cured in all sites, whereas the confidence of curing T4 tumours is far less certain.

 

The ‘N’ refers to the node status: thus if no nodes are palpable to the examining clinician then the patient is stage N0 (good outlook) whereas if there are very large (greater than 6 cm) node masses the patient has stage N3 disease and is at higher risk for subsequent metastatic relapse.

 

The’M’ refers to whether the patient has established metastatic spread beyond the neck nodes at the time of presentation (M0 if absent, M1 if present) and this obviously impacts on the cure chance. The patient therefore has a TNM staging at the end of the staging exercise, which is prognostically useful and helps to ‘pigeon hole’ the patient with regard to optimal therapy.

 

Recently, the introduction of PET (positron emission tomography) scanning has introduced an element of functional scanning into the staging of head and neck cancer, allowing the doctor to tell if equivocal sized neck nodes do or do not contain metastatic cancer.