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Staging and prognosis of head and neck cancers

Staging

The tests help show whether you have a head and neck cancer and whether it has spread. Working out how far the cancer has spread is called staging. It helps your doctors recommend the best treatment for you.

In Australia, the TNM system is the method most often used for staging head and neck cancers. TNM stands for tumour–nodes–metastasis. In this system, each letter is assigned a number to describe the cancer.

T (tumour) 1–4Indicates the size of the primary tumour. Generally, the higher the number, the larger the cancer or the deeper it has grown into the tissue.
N (nodes) 0–3Shows if the cancer has spread to nearby lymph nodes. N0 means the cancer has not spread to the lymph nodes; the more nodes affected or the more cancer there is within the nodes, the higher the number.
M (metastasis) 0–1Shows if the cancer has spread (metastasised) to other parts of the body. M0 means the cancer has not spread; M1 means the cancer has spread.

Based on the TNM numbers, the doctor then works out the cancer’s overall stage on a scale of 1–4 (usually written in Roman numerals as I, II, III or IV). Each type of head and neck cancer is staged slightly differently, and oropharyngeal cancers are staged differently depending on whether they are linked to HPV.

In general, stages 1–2 mean the cancer is small and hasn’t spread from the primary site (early head and neck cancer). Stages 3–4 mean the cancer is larger and has spread (advanced head and neck cancer). It may have spread to nearby tissue or lymph nodes (locally advanced cancer) or to other parts of the body (metastatic cancer). Ask your doctor to explain what the stage of the cancer means for you.

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for anyone to predict the exact course of the disease. Instead, your doctor can give you an idea about the general outlook for people with the same type and stage of cancer.

To work out your prognosis and advise you on treatment options, your doctor will consider your test results, the type of head and neck cancer, your smoking history, the cancer’s HPV status, the rate and depth of the cancer’s growth, the likelihood of response to treatment, and other factors such as your age, level of fitness and overall health.

In most cases, the earlier head and neck cancer is diagnosed, the better the outcome, but people with more advanced head and neck cancer may also respond well to treatment. Oropharyngeal cancers linked with HPV also usually have better outcomes. 

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This information is reviewed by

This information was last updated September 2021 by the following expert content reviewers: A/Prof Richard Gallagher, Head and Neck Surgeon, Director of Cancer Services and Head and Neck Cancer Services, St Vincent’s Health Network, NSW; Dr Sophie Beaumont, Head of Dental Oncology, Dental Practitioner, Peter MacCallum Cancer Centre, VIC; Dr Bena Brown, Speech Pathologist, Princess Alexandra Hospital, and Senior Research Fellow, Menzies School of Health Research, QLD; Dr Teresa Brown, Assistant Director, Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, QLD; Lisa Castle-Burns, Head and Neck Cancer Specialist Nurse, Canberra Region Cancer Centre, The Canberra Hospital, ACT; A/Prof Ben Chua, Radiation Oncologist, Royal Brisbane and Women’s Hospital, GenesisCare Rockhampton and Brisbane, QLD; Elaine Cook, 13 11 20 Consultant, Cancer Council Victoria; Dr Andrew Foreman, Specialist Ear, Nose and Throat Surgeon, Royal Adelaide Hospital, SA; Tony Houey, Consumer; Dr Annette Lim, Medical Oncologist and Clinician Researcher – Head and Neck and Non-melanoma Skin Cancer, Peter MacCallum Cancer Centre and The University of Melbourne, VIC; Paula Macleod, Head, Neck and Thyroid Cancer Nurse Coordinator, Northern Sydney Cancer Centre, Royal North Shore Hospital, NSW; Dr Aoife McGarvey, Physiotherapist and Accredited Lymphoedema Practitioner, Physio Living, Newcastle, NSW; Rick Pointon, Consumer; Teresa Simpson, Senior Clinician, Psycho-Oncology Social Work Service, Cancer Therapy Centre, Liverpool Hospital, NSW.