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Tumour assessment and staging: United Kingdom National Multidisciplinary Guidelines

  • N Roland (a1), G Porter (a2), B Fish (a3) and Z Makura (a4)
Abstract
Abstract

In general, the first decision to be made in a patient with a confirmed head and neck cancer is whether or not to treat the patient before deciding what form of management strategy is appropriate. There is no more important an aspect of head and neck cancer care than the initial evaluation of the patient and the patient's tumour. The practice requires specific expertise and judgement. The current tumour–node–metastasis system relies on morphology of the tumour (anatomical site and extent of disease) but the final decision on treatment hinges on a full assessment of the patient including physiological age and general condition. The aim of this paper is primarily to describe why and how we appraise a patient and their tumour. It addresses the general principles applicable to the topic of evaluation, classification and staging. In addition, the limitations and pitfalls of this process are described.

Recommendations

• All patients with head and neck cancer (HNC) should undergo tumour classification and staging prior to treatment. (R)

• Pre-therapeutic clinical staging of HNCs should be based on at least a C2 factor (evidence obtained by special diagnostic means, e.g. radiographic imaging (e.g. computed tomography, magnetic resonance imaging or ultrasound scan), endoscopy, biopsy and cytology). (R)

• Imaging to evaluate the primary site should be performed prior to biopsy to avoid the effect of upstaging from the oedema caused by biopsy trauma. (G)

• Panendoscopy is only recommended for symptomatic patients or patients with primary tumours known to have a significant risk of a second (synchronous) primary tumour. (G)

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Address for correspondence: Nick Roland, Department of ENT – Head & Neck Surgery, University Hospital Aintree, Liverpool, UK E-mail: DrNJRoland@aol.com
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7 S Sheikhbahaei 1, C Marcus 1, RM Subramaniam . 18F FDG PET/CT and head and neck cancer: patient management and outcomes. PET Clin 2015;10:125–45

10 PO McGarey Jr, AK O'Rourke , SR Owen , DC Shonka Jr, JF Reibel , PA Levine Rigid esophagoscopy for head and neck cancer staging and the incidence of synchronous esophageal malignant neoplasms. JAMA Otolaryngol Head Neck Surg 2016;142:40–5

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13 JF Picirillo . Importance of comorbidity in head and neck cancer. Laryngoscope 2000;110:593602

14 NJ Roland . Staging of Head and Neck Cancer. Scott-Brown's otolaryngology, Head and Neck Surgery, Volume 2. 7th edn.London: Hodder Arnold, 2008;2359–71

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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
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