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If your loved one has recently been diagnosed with head and neck cancer, then his or her doctor probably confirmed the diagnosis with a biopsy. Pieces of information the doctor collected (or will soon gather) include the grade, type and stage of the cancer. This information comes from biopsies, imaging and blood tests. Let’s first briefly review what these tests and evaluations are and what they mean.

Getting to a diagnosis

There are several tests that doctors can use to determine if a person has cancer, what kind it is and how far it may have spread. The main tests that most doctors use to diagnose cancer are biopsies and imaging.

  • Biopsy: A biopsy is a technique in which a tumor or a small piece of a tumor is removed for analysis. A pathologist or cytologist then evaluates the cells under a microscope. If the suspected tumor cells are indeed cancer, called a “malignant” tumor, then the pathologist will confirm the diagnosis of a particular type of head and neck cancer.1Shah JP, Lydiatt W. Treatment of cancer of the head and neck. CA Cancer J Clin. 1995;45:352-368.
  • Imaging: Imaging refers to radiologic studies, or scans, that create pictures of the anatomy inside the head and neck. In general, for small tumors that a doctor can easily see and feel, imaging might not be necessary. For larger tumors, or tumors in locations that are difficult to examine, the doctor will probably order one or more types of imaging to get more information about the tumor location and possible spread to regional lymph nodes. Types of imaging commonly used in the diagnosis of head and neck cancer include X-rays, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) scans.2Marur S, Forastiere AA. Head and neck cancer: changing epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2008 Apr;83(4):489-501.

Refining the diagnosis: type, grade and stage

Once cancer is confirmed, the doctors will need to learn a bit more about the cancer in order to establish the best treatment plan. Your loved one’s care team will probably use imaging scans to identify where the primary (first or main) tumor is and will perform a biopsy on it to determine its type. In the biopsy report, a pathologist will also provide a grade and stage for the cancer, which will help other doctors to decide how to treat it.

  • Type: During a biopsy analysis a pathologist will classify the cell types he or she sees under the microscope; over 90 percent of patients diagnosed with head and neck cancer have squamous cell carcinoma.2Marur S, Forastiere AA. Head and neck cancer: changing epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2008 Apr;83(4):489-501.
  • Grade: The pathologist will also grade the cells, or categorize them by how closely they resemble normal cells. The pathologist will assign a grade to the cells, which typically will range from 1 to 4. If the cells appear normal, then they are categorized as well differentiated and are assigned a score of 1. On the other hand, if the cells appear very abnormal, then they are assigned a score of 4.2Marur S, Forastiere AA. Head and neck cancer: changing epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2008 Apr;83(4):489-501. Grade affects treatment decisions more for some types of head and neck cancer and less for others.
  • Stage: Cancer is staged by the size of the tumor and how far it invades the surrounding tissue.1Shah JP, Lydiatt W. Treatment of cancer of the head and neck. CA Cancer J Clin. 1995;45:352-368.  The staging system used in the U.S. is based first on tumor size (T) and how extensive the tumor is. A doctor will also evaluate whether the cancer has entered regional lymph nodes (N) or whether the cancer has moved (metastasized) to other areas within the body (M), such as the lungs.2Marur S, Forastiere AA. Head and neck cancer: changing epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2008 Apr;83(4):489-501. This is referred to as the TNM staging system, which is the most common staging system used to stage head and neck cancers.

Types of stages typically range from early stage (I), in which a tumor is small and/or it has not yet moved to lymph nodes or distant areas in the body, to advanced stage (IV), in which the tumor is extremely large or it has spread to other body parts.2Marur S, Forastiere AA. Head and neck cancer: changing epidemiology, diagnosis, and treatment. Mayo Clin Proc. 2008 Apr;83(4):489-501.

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

What the diagnosis means: likely treatment course

Treatment recommendations are based on data from the treatment and outcomes of many other patients with similar cancer types and stages. Researchers conduct clinical studies on patients with head and neck cancer. Panels of specialists review the findings of many studies and recommend which treatments are likely to be most helpful for particular groups of patients with similar diagnoses.

The doctor will likely use the NCCN Guidelines for Head and Neck Cancer, in addition to the specific diagnosis and stage, to provide a recommendation for the best treatment course.1, Shah JP, Lydiatt W. Treatment of cancer of the head and neck. CA Cancer J Clin. 1995;45:352-368. 3National Comprehensive Cancer Network Guidelines in Oncology (NCCN Guidelines): Head and Neck Cancers, Version1.2012. Accessed at www.nccn.org on November 25, 2012. In some cases, either the grade and/or the subtype (e.g., squamous cell or another type) will also be used to make a recommendation.

Just because the diagnosis and stage are used to make a recommendation for treatment does not mean this is the only treatment option. Many times, there are several possible treatment options. Also, if it is possible, it is probably a good idea to get a second opinion and decide whether it is the best treatment course for him or her. For example, sometimes patients refuse to have surgery and are treated with radiation therapy instead.

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What the diagnosis means: prognosis

Your loved one’s cancer care team should provide the name of the type of cancer and its grade and stage. This information can be used to provide a prognosis, or an estimate of the likely outcome of the cancer, including the likelihood of survival.

The Surveillance Epidemiology and End Results (SEER) database collects information on cancer from various areas within 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.

People who are diagnosed with an early stage of head and neck cancer will have a better prognosis than patients with late stage disease.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.


References

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

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

3 National Comprehensive Cancer Network Guidelines in Oncology (NCCN Guidelines): Head and Neck Cancers, Version1.2012. Accessed at www.nccn.org on November 25, 2012.

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.