Tongue Base Cancer
Determining Your Prognosis
Your prognosis is a prediction of the outcome of your disease. What is the risk of succumbing to the cancer or the risk of its coming back? These are the big questions on most people’s minds after receiving a diagnosis of throat cancer. Prognosis is based on many factors, and a survival rate is an estimate based on large populations of patients who have been given a similar stage of their throat cancer. There are many specific factors that are unique to each patient that may influence treatment success.
The following aspects of the cancer may affect your prognosis.
| Human Papillomavirus (HPV) Status | Unlike other head and neck cancers, squamous cell cancers of the oropharynx can be divided into HPV-related and HPV-unrelated cancers. Details are still being worked out, but it is becoming clear that with current treatment methods, patients with HPV-related oropharynx cancer have a better chance at being cured than those with HPV-unrelated oropharynx cancer.1 Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tân PF, Westra WH, Chung CH, Jordan RC, Lu C, Kim H, Axelrod R, Silverman CC, Redmond KP, Gillison ML. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010 Jul 1;363(1):24-35. doi: 10.1056/NEJMoa0912217. Epub 2010 Jun 7. |
| Stage | It is very important to know the stage to help determine your chance of cure.13 Jan JC, Hsu WH, Liu SA, Wong YK, Poon CK, Jiang RS, Jan JS, Chen IF. Prognostic factors in patients with buccal squamous cell carcinoma: 10-year experience. J Oral Maxillofac Surg. 2011 Feb;69(2):396-404. However, the staging system at this point does not separate HPV-positive from HPV-negative cancers. |
| Spread to Lymph Nodes Spread of Cancer Cells Outside Lymph Node Capsule | This goes along with stage. However, even without other factors, if there is spread to lymph nodes in the neck, there’s a diminished chance of cure. This is particularly true if there is evidence of spread of cancer outside the lymph node.13 Jan JC, Hsu WH, Liu SA, Wong YK, Poon CK, Jiang RS, Jan JS, Chen IF. Prognostic factors in patients with buccal squamous cell carcinoma: 10-year experience. J Oral Maxillofac Surg. 2011 Feb;69(2):396-404.Still, for HPV-related oropharynx cancer, there is some data indicating that spread outside of lymph nodes is not as bad a sign as HPV-unrelated oropharynx cancer.14Sinha P, Lewis JS Jr, Piccirillo JF, Kallogjeri D, Haughey BH. Extracapsular spread and adjuvant therapy in human papillomavirus-related, p16-positive oropharyngeal carcinoma. Cancer. 2012 Jul 15;118(14):3519-30. |
| Tumor Margins | The ability to completely remove the tumor can be a very important factor that will influence the likelihood of being cured.13, Jan JC, Hsu WH, Liu SA, Wong YK, Poon CK, Jiang RS, Jan JS, Chen IF. Prognostic factors in patients with buccal squamous cell carcinoma: 10-year experience. J Oral Maxillofac Surg. 2011 Feb;69(2):396-404.15 Pradhan SA, Rajpal RM. Marginal mandibulectomy in the mangement of squamous cancer of the oral cavity. Indian J Cancer. 1987;24; 167-171. |
| Spread into Local Structures | Spread into large nerves, vessels or lymphatics might make your prognosis worse.15, Pradhan SA, Rajpal RM. Marginal mandibulectomy in the mangement of squamous cancer of the oral cavity. Indian J Cancer. 1987;24; 167-171.16 Maddox WA, Urist MM. Histopathological prognostic factors of certain primary oral cavity cancers. 1990 Dec;4(12):39-42; discussion 42, 45-6. |
To give you a percentage chance of cure is difficult because the SEER data groups different types of cancers together and may include patients from a long time ago. SEER stands for Surveillance Epidemiology and End Results. It is a cancer database maintained by the National Cancer Institute. This database collects statistics on patients with cancer around the country. Most importantly, much of the data in these large databases do not separate HPV-positive from HPV-negative oropharynx cancers. In general, for patients with cancer of the oropharynx (including soft palate), SEER data and AJCC show the following17 Piccirillo JF, Costas I, Reichman ME. Chapter 2: Cancers of the Head and Neck. Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007.:
| Estimated Disease-Specific Survival at Five Years17 Piccirillo JF, Costas I, Reichman ME. Chapter 2: Cancers of the Head and Neck. Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007. | Estimated Disease-Specific Survival at Ten Years17 Piccirillo JF, Costas I, Reichman ME. Chapter 2: Cancers of the Head and Neck. Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD, Horner M-J (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. National Cancer Institute, SEER Program, NIH Pub. No. 07-6215, Bethesda, MD, 2007. | Estimated Disease-Specific Survival at Five Years18 Edge SB, et al. The AJCC Cancer Staging Manual – Seventh Edition. American Joint Committee on Cancer 2010. | |
| Oropharynx Cancer (1988-2001) | Oropharynx Cancer (1988-2001) | Oropharynx Cancer (1998-1999) | |
| Stage I | 56% | 42% | 73% |
| Stage II | 58% | 46% | 58% |
| Stage III | 55% | 44% | 45% |
| Stage IV | 43% | 37% | 32% |
Estimated Disease-Specific Survival is the percentage of people with a specific cancer who are alive at a given time point, such as five years after diagnosis. It excludes people who may have died from a disease other than their cancer. It is probably the best estimate we have in these large national databases as to the prognosis of a particular type of cancer at each stage.
A very interesting study that looked at survival in HPV-related oropharynx cancers versus non-HPV related oropharynx cancers revealed some interesting results. This study found that for Stage III and Stage IV oropharynx cancer, there was a difference in survival after three years based on the HPV status (82 percent in HPV positive cancers versus 57 percent in HPV negative cancers).1 Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tân PF, Westra WH, Chung CH, Jordan RC, Lu C, Kim H, Axelrod R, Silverman CC, Redmond KP, Gillison ML. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med. 2010 Jul 1;363(1):24-35. doi: 10.1056/NEJMoa0912217. Epub 2010 Jun 7.
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