Head and neck cancer staging
What is a “stage” of head and neck cancer?
When it concerns cancer, the word “stage” refers to the extent of the disease.
Head and neck cancer staging involves both the size of the tumor and whether or
not it has spread to other parts of the body such as the lymph nodes.
Staging is very important, because it helps healthcare professionals determine whether
or not to try a particular treatment.
Stages of head and neck cancer start at 0 and go up to 4, but they are written in
Roman numerals (I–IV). Generally, a lower number means the cancer has spread less.
A higher number means the cancer has spread more.
The stages of head and neck cancer and what they mean
Stage 0 head and neck cancer.
The tumor is “in situ.” It’s stayed in the part of the head and neck where it started,
and it’s not invasive, meaning it has not spread. Still, carcinomas
in situ can become malignant (dangerous), and doctors may recommend
removing them
Treatment.
The usual treatment is to remove the top layers of tissue along with a small margin
of normal tissue. This is known as surgical stripping or thin resection.
Close follow-up to see if any cancer has come back (recurrence) is important. Carcinoma
in situ that keeps coming back after resection may require radiation therapy.
The stages of head and neck cancer and what they mean
Stage I head and neck cancer.
The tumor hasn’t spread to the lymph nodes or to distant areas of the body
Treatment.
A local therapy is likely, meaning surgery or radiation therapy. Both therapies
work well for treating early-stage head and neck cancer, and which treatment is
chosen depends on where the cancer has developed. If a tumor is caught early, surgery
may be able to remove all of it
The stages of head and neck cancer and what they mean
Stage II head and neck cancer.
The tumor is larger, but may not have spread to the lymph nodes or to distant areas
of the body
Treatment.
A local therapy is likely, meaning as surgery or radiation therapy. Both therapies
work well for treating early-stage head and neck cancer, and which is chosen depends
on where the cancer has developed
The stages of head and neck cancer and what they mean
Stage III head and neck cancer.
The tumor is either much larger, or it has begun to spread to the lymph nodes or
to distant areas of the body
Treatment.
A combination of therapies such as surgery and radiation or radiation and chemotherapy
is likely. Radiation therapy is often needed after surgery, especially if the cancer
has spread to the lymph nodes. Tumors that are too big to be completely removed
by surgery are usually treated with radiation, possibly with chemotherapy
The stages of head and neck cancer and what they mean
Stage IV head and neck cancer.
The tumor is much larger and has spread to the lymph nodes. It may have also spread
to other areas of the body
Treatment.
A treatment such as chemotherapy is likely, often in combination with surgery to
remove the tumor. Chemotherapy may be given before and after the surgery
to increase the chance that the cancer doesn’t come back (that you don’t have a
recurrence of cancer)
What system do doctors use when staging cancer?
The Staging System of the American Joint Committee on Cancer, also referred to as
the TNM system, is used most often by doctors to describe a patient's cancer.
The TNM system involves three scores that describe:
- T = The tumor type and extent
- N = Whether or not lymph nodes are involved
- M = How far the cancer has spread (metastasized)
Tumor, Node, and Metastasis (TNM) staging
Primary tumor (T)
|
T0
|
There is no evidence of a tumor
|
|
Tis:
|
The tumor is “in situ,” meaning it has not spread to nearby tissues
|
|
T1
|
The tumor cannot be seen without using imaging techniques
|
|
T2-4
|
The higher numbers indicate the involvement of the lymph nodes and extent of the
primary tumor
|
Nodes (N)
|
N0
|
The cancer has not spread to the lymph nodes
|
|
N1-4
|
The cancer has spread to the lymph nodes. The higher numbers indicate how many lymph
nodes are affected and how far away the cancer has spread
|
Metastasis (M)
|
M0
|
No distant metastasis, meaning the cancer has not spread to other organs
|
|
M1
|
Distant metastasis, meaning the cancer has spread to other organs
|
What does each number mean?
Staging is different for each type of head and neck cancer and for each patient.
The TNM system is designed to help your healthcare team assess a specific cancer,
but it doesn’t always translate directly into one of the main 4 stages. For example,
a very large tumor may be staged the same as a much smaller one that has also spread
to the lymph nodes.
In addition to a stage, a head and neck cancer may be given a grade
according to how normal or abnormal the cancer cells look under a microscope. A
higher-grade cancer is more likely to spread quickly.
People fighting head and neck cancer who are in otherwise good health can take part
in clinical trials of other new potential treatments.
Head and neck cancer staging is complex, so be sure to ask your doctors and nurses
any questions you have about it.
Learn about head and neck cancer risk factors
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