Future of the TNM classification and staging system in head and neck cancer

Abstract

Staging systems for cancer, including the most universally used TNM classification system, have been based almost exclusively on anatomic information. However, the question arises whether staging systems should be based on this information alone. Other parameters have been identified that should be considered for inclusion in classification systems like the TNM. This is all the more important, as a shift toward nonsurgical treatments for head and neck cancer has been made over the years. For these treatment modalities tumor/biologic characteristics next to anatomic information may be particularly important for treatment choice and outcome. The shortcomings of the current TNM classification system will be discussed, along with suggestions for improvement and expansion of the TNM system based on tumor, patient, and environment-related factors. Further improvement of the TNM classification is expected to result in better treatment choices, outcome and prognostication of patients with head and neck cancer.

Prognostic significance of standardized uptake value and metabolic tumour volume on 18F-FDG PET/CT in oropharyngeal squamous cell carcinoma

“…Lymph node (N) staging evaluates the number, size and side of metastatic lymph nodes [9], which is not an accurate representation of metastatic burden. Therefore, the identification of reliable prognostic factors predictive of treatment outcomes is necessary [7,8].…”

“…Although the American Joint Committee on Cancer (AJCC) tumour-node-metastasis (TNM) staging system is a widely accepted prognostic indicator, this system is based almost exclusively on anatomical information and has limited prognostic accuracy [7,8]. Primary tumour (T) staging indicates tumour size and its relationship with adjacent tissues [9], which is not representative of the three-dimensional volume or the biological behaviour of tumours.…”

Role of infectious agents in the carcinogenesis of brain and head and neck cancers

“…The classification of these tumours is based mostly on histological and clinical findings [4,5]. Most head and neck cancers are squamous cell carcinomas progressing from the thin epithelial lining of the head and neck tissue.…”

Do Radiologists Report the TNM Staging in Radiology Reports for Head and Neck Cancers? A National Survey Study

“…The 2 most frequent responses to potential reasons for not stating the TN stage in reports or barriers to such staging were fear of inaccuracies and being unable to remember the staging classification (Table 2). These responses may be due to the periodic changes of TNM classification 9 because the system is reviewed every 7-10 years and there are changes in the staging system at various subsites. Approximately one-third thought that reporting staging was not required, and 18% did not give the stage due to lack of reimbursement.…”