Future of the TNM classification and staging system in head and neck cancer. Head Neck 2010 (Epub ahead of print)

Department of Otolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
Head & Neck (Impact Factor: 2.64). 12/2010; 32(12):1693-711. DOI: 10.1002/hed.21361
Source: PubMed


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.

Download full-text


Available from: Juan P Rodrigo, Oct 03, 2015
1 Follower
89 Reads
  • Source
    • "Each year, 500,000 new head and neck cancer cases are diagnosed worldwide [3]. 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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This review concentrates on tumours that are anatomically localised in head and neck regions. Brain cancers and head and neck cancers together account for more than 873,000 cases annually worldwide, with an increasing incidence each year. With poor survival rates at late stages, brain and head and neck cancers represent serious conditions. Carcinogenesis is a multi-step process and the role of infectious agents in this progression has not been fully identified. A major problem with such research is that the role of many infectious agents may be underestimated due to the lack of or inconsistency in experimental data obtained globally. In the case of brain cancer, no infection has been accepted as directly oncogenic, although a number of viruses and parasites are associated with the malignancy. Our analysis of the literature showed the presence of human cytomegalovirus (HCMV) in distinct types of brain tumour, namely glioblastoma multiforme (GBM) and medulloblastoma. In particular, there are reports of viral protein in up to 100% of GBM specimens. Several epidemiological studies reported associations of brain cancer and toxoplasmosis seropositivity. In head and neck cancers, there is a distinct correlation between Epstein-Barr virus (EBV) and nasopharyngeal carcinoma (NPC). Considering that almost every undifferentiated NPC is EBV-positive, virus titer levels can be measured to screen high-risk populations. In addition there is an apparent association between human papilloma virus (HPV) and head and neck squamous cell carcinoma (HNSCC); specifically, 26% of HNSCCs are positive for HPV. HPV type 16 was the most common type detected in HNSCCs (90%) and its dominance is even greater than that reported in cervical carcinoma. Although there are many studies showing an association of infectious agents with cancer, with various levels of involvement and either a direct or indirect causative effect, there is a scarcity of articles covering the role of infection in carcinogenesis of brain and head and neck cancers. We review recent studies on the infectious origin of these cancers and present our current understanding of carcinogenic mechanisms, thereby providing possible novel approaches to cancer treatment.
    Infectious Agents and Cancer 02/2013; 8(1):7. DOI:10.1186/1750-9378-8-7 · 2.36 Impact Factor
  • Source
    • "Accurate prediction of prognosis is important for the planning of effective treatment regarding cancer patients. However, due to the limitations of the conventional system alone, there is a need for more accurate and reliable methods of determining prognosis (1-5). In order to accomplish this, all the characteristics of a tumor, including biological, molecular, and clinical features, should be incorporated into the estimation of the patient's prognosis. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Accurate prediction of cancer prognosis before the start of treatment is important since these predictions often affect the choice of treatment. Prognosis is usually based on anatomical staging and other clinical factors. However, the conventional system is not sufficient to accurately and reliably determine prognosis. Metabolic parameters measured by (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) have the potential to provide valuable information regarding prognosis and treatment response evaluation in cancer patients. Among these parameters, volume-based PET parameters such as metabolic tumor volume and total lesion glycolysis are especially promising. However, the measurement of these parameters is significantly affected by the imaging methodology and specific image characteristics, and a standard method for these parameters has not been established. This review introduces volume-based PET parameters as potential prognostic indicators, and highlights methodological considerations for measurement, potential implications, and prospects for further studies.
    Korean journal of radiology: official journal of the Korean Radiological Society 01/2013; 14(1):1-12. DOI:10.3348/kjr.2013.14.1.1 · 1.57 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A new two-dimensional position-sensitive detector system for small-angle neutron scattering experiments is under development. It is based on a 60×60 cm<sup>2</sup> large <sup>6</sup>Li-glass scintillator for the neutron capture and dispersion of the emitted light on an array of photomultiplier tubes for the derivation of the event position. For subthermal neutrons of 8 Å, an efficiency of 96% and a spatial resolution of 8 mm are to be achieved. Major improvements have been made in the signal- and data-processing branch, which aims at an electronic dead time of 1 μs. A fast digitalization method using free-running analog-to-digital converters for each photomultiplier combined with field-programmable gate arrays for a parallel event detection in all channels has been applied. A subsequent farm of up to 16 floating-point digital signal processors is used to provide enough computing power for an improved reconstruction of the event position according to a maximum likelihood method
    IEEE Transactions on Nuclear Science 09/2001; 48(4-48):1114 - 1117. DOI:10.1109/23.958733 · 1.28 Impact Factor
Show more