Head and neck cancer staging - A review

Head and neck cancer has substantial world-wide impact. Squamous cell carcinoma (SCC) which comprises greater than 90% of head and neck cancer is found within multiple anatomic subsites and behaves differently then many solid tumors. Treatment failures are most commonly due to local or regional recurrences rather than distant metastasis. Accurate staging of the initial primary and regional lymph nodes is, therefore, critical to assessing the nature and behavior of the disease. For this reason, an international governing body to develop guidelines for staging has evolved since the 1930's. The purpose of this body has been to group patients with head and neck cancer accurately according to the extent of local, regional and distant disease. Continued modifications are required to keep abreast of the changing patterns of disease and treatment. Currently, the TMN staging system is based on anatomic location and size, extent, number and size of regional lymph nodes and presence or absence of distant spread as well as incorporating the resectability of disease. However, the TMN system does have its deficiencies in that it fails to incorporate histology and genetic features that may predict patients' survival more accurately. Future aims to assimilate genetic features, viral associations and concomitant patient co-morbidities into staging systems may benefit patients' therapeutic options and more precisely describe prognosis.