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Staging and prognosis of head and neck cancers

Staging

Tests 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 health care team 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. The higher the number, the larger the cancer.
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, 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 (I–IV). Each head and neck cancer is staged slightly differently. In general, in stages I–II the cancer is small and hasn’t spread from the primary site (early head and neck cancer). In stages III–IV the cancer is larger and has spread to other parts of the body or the lymph nodes (advanced head and neck cancer). If you are finding it hard to understand staging, ask someone in your health care team to explain it in a way that makes sense to 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 prognosis for people with the same type and stage of cancer. To work out your prognosis, your doctor will consider:

  • your test results
  • the type of head and neck cancer
  • the tumour’s HPV status
  • the rate and depth of tumour growth
  • the likelihood of response to treatment
  • other factors such as your age, level of fitness and overall health.

These factors will also help your doctor advise you on the best treatment options. Usually 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 associated with HPV also tend to have better outcomes.

This information is reviewed by

This information was last updated September 2019 by the following expert content reviewers: A/Prof David Wiesenfeld, Oral and Maxillofacial Surgeon, Director, Head and Neck Tumour Stream, The Victorian Comprehensive Cancer Centre at Melbourne Health, VIC; Alan Bradbury, Consumer; Dr Ben Britton, Senior Clinical and Health Psychologist, John Hunter Hospital, NSW; Dr Madhavi Chilkuri, Radiation Oncologist, Townsville Cancer Centre, The Townsville Hospital, QLD; Jedda Clune, Senior Dietitian (Head and Neck Cancer), Sir Charles Gairdner Hospital, WA; Dr Fiona Day, Staff Specialist, Medical Oncology, Calvary Mater Newcastle, and Conjoint Senior Lecturer, The University of Newcastle, NSW; Dr Ben Dixon, ENT, Head and Neck Surgeon, Peter MacCallum Cancer Centre and St Vincent’s Hospital Melbourne, VIC; Emma Hair, Senior Social Worker, St George Hospital, NSW; Rosemerry Hodgkin, 13 11 20 Consultant, Cancer Council WA; Kara Hutchinson, Head and Neck Cancer Nurse Coordinator, St Vincent’s Hospital Melbourne, VIC; A/Prof Julia Maclean, Speech Pathologist, St George Hospital, NSW; Prof Jane Ussher, Chair, Women’s Health Psychology, Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, NSW; Andrea Wong, Physiotherapist, St Vincent’s Hospital Melbourne, VIC..