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The clinician who diagnosed your loved one with head and neck cancer likely obtained the results from a biopsy. There is other information the doctor also collected (or will soon gather), which includes the grade, histology subtype and stage of the cancer. Let’s briefly review what these tests and evaluations are and what information they provide.

Biopsy, grade, histological subtype and stage

  • Biopsy: A biopsy is the removal of tissue from a suspicious lesion and the examination of it, usually at a microscopic level, to establish a diagnosis. If the examined cells in a biopsy are indeed malignant (cancerous), the pathologist will confirm the diagnosis of the particular type of head and neck cancer based on the evaluation of the cells.
  • Grade: The pathologist will also grade the cells, or categorize them, by how well defined the cells appear (in other words, how closely they resemble normal cells). The pathologist will assign a grade to the cells, which typically ranges from 1 to 4. If the cells appear normal, then they are categorized as well differentiated and are assigned a score of 1. Conversely, if the cells appear very abnormal, then they are assigned a score of 4.2Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.
  • Histological subtype: The pathologist will also classify the cell types; over 90 percent of patients diagnosed with head and neck cancer have squamous cell carcinoma.
  • Stage: Cancer is staged by the size of the tumor and how extensive it is within the body.The staging system used in the U.S. is based on tumor size (T) its extent (for example, whether the malignancy has entered regional lymph nodes) (N) or whether the cancer has traveled (metastasized) to distant sites within the body (M), such as the lungs.2Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

Evaluating how extensive the cancer is within the body involves the use of imaging devices, such as computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET). Imaging can help doctors find the primary (first) tumor, what nearby anatomy may be involved and whether the cancer has spread to other parts of the body.

Cancer stages typically range from an early stage (I), with the smallest tumor size that has not yet extended to lymph nodes or distant sites in the body, to stage (IV), with either the largest tumor size or spread to distant sites in the body.2Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

Why is the specific type of head and neck cancer, along with the assigned grade and stage, important? We’ll look at what this information means in the next two sections.

What diagnosis means: prognosis

Your health care provider should have provided you with the name of the type of cancer, its grade and its stage. The clinician can then use that information to provide a prognosis, or an estimate of the probable outcome of your loved one’s cancer, which includes the likelihood of survival.2Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

The Surveillance Epidemiology and End Results (SEER) database collects information on cancer from various regions of the U.S.; this information can then be used to determine the average outcomes of similar patients.4Surveillance Epidemiology and End Results (SEER) Website. Accessed at seer.cancer.gov on February 17, 2013.

In general, people diagnosed with an early stage of head and neck cancer will have a better prognosis than patients with late-stage disease. For example, after five years, most patients diagnosed with stage I or II head and neck cancer will be alive, but those in later stages at the time of diagnosis have a reduced chance of achieving a cancer-free state.5Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations), National Cancer Institute. Bethesda, MD, Accessed at http://seer.cancer.gov/csr/1975_2009_pops09/, based on November 2011 SEER data submission, posted to the SEER web site, 2012.

The grade is also related to prognosis; a person with normal-appearing cells (grade 1) will have a better prognosis than a person with cells that appear very abnormal (grade 4).2Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

See the article about your particular cancer type and talk to your doctor to learn more about your prognosis.

What diagnosis means: likely treatment course

Researchers have conducted numerous clinical studies evaluating therapies for patients with head and neck cancer. A panel of specialists has evaluated the findings from these clinical studies and recommended which treatments are likely to be most beneficial for particular subsets of patients and placed these recommendations in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers.2Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

Your loved one’s doctor will likely use the type of cancer, stage and NCCN Guidelines® to provide a recommendation for the best treatment options.1, Shah JP, Lydiatt W. Treatment of cancer of the head and neck. CA Cancer J Clin. 1995;45:352-368.2Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org. The clinician may also use the grade and/or the histological subtype to make a treatment recommendation.

However, there are often several possible treatment options.2Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org. Every patient can evaluate the available information and decide whether it is the best treatment course. For example, sometimes people refuse surgery, and doctors will instead treat them with systemic therapy, radiation therapy or both.

Re-evaluation: obtaining a second opinion

You may want to consider identifying medical facilities that have specialists with an expertise in head and neck cancer to receive a second opinion. You can provide this list of medical facilities to your loved one, and he or she can then decide on the best option.

The NCCN Guidelines for Head and Neck Cancers recommend that patients be treated at high-volume centers by a multidisciplinary team with expertise in head and neck cancer.2Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org. Moreover, researchers found that specialists versus non-specialists performed more accurate diagnoses.6Hillner BE, Smith TJ, Desch CE. Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol. 2000 Jun;18(11):2327-40. The NCCN Guidelines recommend treatment choices based on the diagnosis;2Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org. therefore, an accurate diagnosis is essential to selecting the best treatment option.

Head and neck cancers represent about 3 percent of all cancers, which makes them fairly uncommon.3Marur S, Forastiere AA. Head and neck cancer: changing epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2008 Apr;83(4):489-501. A hospital in a rural area, for example, may not see a high volume of head and neck cancer patients, which could potentially result in inaccurate diagnosis and could in turn result in the selection of a suboptimal treatment management plan.

I actually felt quite relieved when I was diagnosed with cancer because there was some plan that was laid out for what the doctor was going to do to address the issue.Gordon O. (laryngeal cancer survivor)

References

1 Shah JP, Lydiatt W. Treatment of cancer of the head and neck. CA Cancer J Clin. 1995;45:352-368.

2 Referenced with permission from The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Head and Neck Cancers V.2.2016. © National Comprehensive Cancer Network, Inc 2016. All rights reserved. Accessed November 18, 2016. To view the most recent and complete version of the guideline, go online to www.nccn.org.

3 Marur S, Forastiere AA. Head and neck cancer: changing epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2008 Apr;83(4):489-501.

4 Surveillance Epidemiology and End Results (SEER) Website. Accessed at seer.cancer.gov on February 17, 2013.

5 Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations), National Cancer Institute. Bethesda, MD, Accessed at http://seer.cancer.gov/csr/1975_2009_pops09/, based on November 2011 SEER data submission, posted to the SEER web site, 2012.

6 Hillner BE, Smith TJ, Desch CE. Hospital and physician volume or specialization and outcomes in cancer treatment: importance in quality of cancer care. J Clin Oncol. 2000 Jun;18(11):2327-40.