Head and Neck Cancer – Oral Cavity (Mouth) and Throat (Oropharynx, Nasopharynx, Hypopharynx)

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Oral Cavity (Mouth) Cancer

oral cavity cancer normal anatomy

TNM Staging of Oral Cavity (Mouth) Cancer

T STAGING

Tis – Carcinoma in situ or cancerous lesion is present only in the superficial layer of the oral cavity.

T1 – The primary tumor is </=2 cm in size and the depth of invasion (DOI) is </=5 mm. No spread to nearby lymph nodes or distant body parts. T1, size less than 2 cm T2 – The primary tumor is </=2 cm in size with the DOI between 5 mm and 10 mm or primary tumor is >2 cm but </=4 cm with the DOI </=10 mm. stage T2 T3 – The primary tumor is >4 cm in size with the DOI between 10 mm and 20 mm. stage T3 oral (mouth) cancer TNM staging T1 to T3 T4a – The primary tumor invades adjacent structures and/or DOI > 20 mm.

T4a - invades maxillary sinus T4a - invades the skin of the face T4a - invades maxilla or mandible bone T4b – The primary tumor of any size that has invaded a vital structure, such as masticator space, pterygoid plates, skull base and/or surrounds the carotid artery. T4b - invades masticator space, pterygoid plate, internal carotid artery oral (mouth) cancer TNM staging T4

N STAGING

N0 – No spread of tumor to nearby lymph nodes

N1 – The disease has spread to a single ipsilateral lymph node measuring </=3 cm without extranodal involvement. nodal stage N1 - single ipsilateral lymph node measuring </=3 cm N2a – The disease has spread to a single ipsilateral lymph node measuring >3 cm and </= 6 cm nodal stage N2a - single ipsilateral lymph node measuring >3 cm and </= 6 cm N2b – Metastasis to multiple ipsilateral nodes, none >6 cm nodal stage N2b - multiple ipsilateral nodes, none >6 cm N2c – Metastasis to bilateral/contralateral lymph nodes, all measuring <6 cm without extranodal involvement. nodal stage N2c - bilateral/contralateral lymph nodes, all measuring <6 cm N3 – The disease has spread to lymph nodes measuring >6 cm or extranodal involvement. nodal stage N3 - lymph nodes measuring >6 cm N3 - extranodal involvement head and neck cancer N staging

M STAGING

M0 – No spread to distant body parts

M1 – Spread of the tumor to distant body parts.

4 Stages of Oral Cavity (Mouth) Cancer

Based on the TNM classification discussed above, oral cavity cancer is assigned a stage from I to IV.

STAGE TNM    
0 Tis N0 M0    
I T1 N0 M0    
II T2 N0 M0    
III T1-2 N1 M0    
  T3 N0-1 M0    
IVA T1-3 N2 M0    
  T4a N0-2 M0    
IVB Any T N3 M0    
  T4b Any N M0    
IVC Any T Any N M1    

What is the Survival Rate/ Life Expectancy according to Stage of Oral Cavity (Mouth) Cancer?

For Lip Cancer

5 year survival is as follows.

Localised Disease- 92%.

Regional Disease – 60%.

Distant Disease – 28%.

For Tongue Cancer

5 year survival is as follows.

Localised Disease- 81%.

Regional Disease – 68%.

Distant Disease – 39%.

For Floor of Mouth Cancer

5 year survival is as follows.

Localised Disease- 77%.

Regional Disease – 38%.

Distant Disease – 20%.

Treatment of Oral Cavity (Mouth) Cancer

Oral Cavity Cancer Treatment Infographic

Stage 0

For Stage 0 cancers, surgical resection of the involved site is considered as the standard treatment. The patient should be followed-up closely after treatment for any sign of recurrence.

Stage I and II

For Stage I and II cancers, surgery is considered as the preferred treatment. Surgical resection of the involved site along with lymph node dissection is generally employed. Radiation therapy with or without chemotherapy may be employed after the primary treatment to kill any remaining cancer cells or in the presence of any adverse prognostic features. The patient should be followed-up closely after treatment for any sign of recurrence.

Stage III and IVA

For Stage III to IVA cancers, any of the following 3 approaches can be utilized as the preferred treatment:

1) Start treatment with chemotherapy (induction therapy) followed by radiation therapy or radiotherapy + chemotherapy based on the extent of tumor shrinkage with primary treatment.

2) Surgery is employed as the first-line treatment and involves the resection of the primary tumor along with any affected lymph nodes. This is followed by radiation therapy or radiotherapy + chemotherapy based on the presence of any adverse prognostic features.

3) Chemotherapy + radiotherapy or radiotherapy alone can be employed as the primary treatment. Surgery may be employed to remove any remnant cancer tissue.

Stage IVB

For Stage IVB cancer, radiotherapy along with chemotherapy or targeted therapy is usually employed as the first-line treatment. Surgery may be employed if the tumor shrinks sufficiently that it can be removed with surgery. Radiation therapy may be employed as palliative treatment.

Stage IVC

For Stage IVC cancer, chemotherapy, immunotherapy or targeted therapy are the treatment options. Radiation therapy may be employed as palliative treatment.

treatment for metastatic disease infographic

Oropharyngeal Cancer

oropharyngeal-cancer

TNM Staging

T STAGING

Tis – Carcinoma in situ or cancerous lesion is present only in the superficial layer of the oropharynx.

T1 – The primary tumor is </=2 cm in size. stage T1 T2 – The primary tumor is >2 cm but </=4 cm in size. T2 stage T3 – The primary tumor is >4 cm in size or has invaded into the lingual surface of the epiglottis. T3 stage Oropharyngeal Cancer T Staging T1 to T3 T4a – The primary tumor has invaded any of the adjacent structure, such as larynx, hard palate, or mandible. stage T4a, invades tongue stage T4a, invades hard palate stage T4a, invades larynx stage T4a, invades medial pterygoid muscle stage T4a, invades mandible T4b – The primary tumor of any size that has invaded a vital structure, such as pterygoid plates, lateral nasopharynx, or skull base and/or surrounds the carotid artery. stage T4a, invades medial pterygoid muscle stage T4b, invades skull base stage T4b, invades lateral pterygoid, ptergoid plates, carotid oropharyngeal cancer T staging infographic

N STAGING

N0 – No spread of tumor to nearby lymph nodes

N1 – The disease has spread to a single ipsilateral lymph node measuring </=3 cm without extranodal involvement. nodal stage N1 - single ipsilateral lymph node measuring </=3 cm N2a – The disease has spread to a single ipsilateral lymph node measuring >3 cm and </= 6 cm nodal stage N2a - single ipsilateral lymph node measuring >3 cm and </= 6 cm N2b – Metastasis to multiple ipsilateral nodes, none >6 cm nodal stage N2b - multiple ipsilateral nodes, none >6 cm N2c – Metastasis to bilateral/contralateral lymph nodes, all measuring <6 cm without extranodal involvement. nodal stage N2c - bilateral/contralateral lymph nodes, all measuring <6 cm N3 – The disease has spread to lymph nodes measuring >6 cm or significant extranodal involvement. nodal stage N3 - lymph nodes measuring >6 cm Oropharyngeal cancer nodal stage N3 head and neck cancer N staging

M STAGING

M0 – No spread to distant body parts

M1 – Disease has spread to distant body parts

What are the 4 Stages of Oropharyngeal (Throat) Cancer?

STAGE TNM    
0 Tis N0 M0    
I T1 N0 M0    
II T2 N0 M0    
III T3 N0 M0    
  T1-3 N1 M0    
IVA T1-3 N2 M0    
  T4a N0-2 M0    
IVB Any T N3 M0    
  T4b Any N M0    
IVC Any T Any N M1    

What is the Survival Rate/ Life Expectancy according to Stage of Oropharyngeal Cancer?

Survival rates  is calculated based on whether the disease is Localised, Regional or Distant.

Localised

  • Cancer is limited to the oropharynx
  • 5 year survival 84%.

Regional

  • Cancer has spread to nearby structures or lymph nodes
  • 5 year survival 65%.

Distant

  • Cancer has spread to distant body parts.
  • 5 year survival 39%.

Treatment of Oropharyngeal (Throat) Cancer

Apart from the stage of disease, the selection of treatment usually depends upon the location of disease, patient’s preference, performance status of the patient, along with other factors. Following are the preferred treatment approaches for different stages of oropharyngeal cancer, but the final decision is taken after clinical assessment of the patient by an oncologist.

Non Metastatic Oropharyngeal Cancer Treatment

Stage 0

For Stage 0 cancers, surgical resection of the involved site is considered as the standard treatment. The patient should be followed-up closely after treatment for any sign of recurrence.

Stage I and II

For Stage I and II cancers, radiotherapy is considered as the preferred treatment. Surgical resection is also an option. Chemoradiation is also an option that may be used either alone or after surgery in patients with adverse risk factors.

Stage III to IVB

For Stage III to IVB cancer, a combination of radiotherapy and chemotherapy or targeted therapy is usually employed as the first-line treatment. Induction chemotherapy may be required in some cases. Surgical resection may also be an option in some cases.

Stage IVC

For Stage IVC cancer, chemotherapy, immunotherapy or targeted therapy are the treatment options. Radiation therapy may be employed as palliative treatment.

treatment for metastatic head and neck cancer

Nasopharyngeal Cancer

nasopharyngeal-cancer The upper part of the pharynx behind the nose is known as nasopharynx. Nasopharyngeal cancers are rare and are mostly reported in specific geographical regions, such as Southeast Asia, Micronesia/Polynesia, Eastern Asia, and North Africa. These are 2 to 3 times more common in men than women. Based on the appearance of cancer cells, nasopharyngeal cancers are divided into 3 categories:

  • Keratinizing SCC,
  • Non-keratinizing differentiated carcinoma, and
  • Undifferentiated carcinoma

Epstein-Barr Virus (EBV) has been reported to play a role in the development of nasopharyngeal cancers.

TNM Staging

T STAGING

T1 – The primary tumor is limited to the nasopharynx, or extension to the oropharynx and/or nasal cavity without para-pharyngeal involvement. T1, confined to nasopharynx T1, extends to nasal cavity T1, extends to oropharynx T2 – The primary tumor has invaded into the para-pharyngeal space, and/or an adjacent structure such as medial pterygoid, lateral pterygoid, or prevertebral muscles. T2, extends to parapharyngeal space T3 – The primary tumor has invaded into the skull base, cervical vertebra, pterygoid structures, and/or paranasal sinuses. T3, extends to skull base T3, invades pterygoid structures T3, invades pterygoid structures nasopharyngeal cancer anatomy and T staging  T1 to T3 T4 – The primary tumor has invaded into the cranium, cranial nerves, hypopharynx, orbit, parotid gland, and/or extensive invasion beyond the lateral pterygoid muscle. T4, intracranial extensio T4, extends to hypopharynx nasopharyngeal-cancer-T-staging T3 and T4

N STAGING

N0 – No spread to nearby lymph nodes

N1 – Spread to cervical lymph node(s) on one side and/or retropharyngeal lymph node(s) with lymph nodes measuring </=6 cm. cervical lymph node involvement N1 N2 – The disease has spread to cervical lymph node(s) one both sides and/or retropharyngeal lymph node(s) with lymph nodes measuring </=6 cm. N2 nodes - cervical lymph node(s)  measuring </=6 cm.  N3a – The disease has spread to cervical lymph node(s) on one or both sides with lymph nodes measuring >6 cm. N3a nodes - cervical lymph node(s) measuring >6 cm. N3b – Cervical lymph node metastasis below cricoid cartilage N3b nodes - nodes below cricoid cartilage nasopharyngeal cancer N staging

M STAGING

M0 – No spread of disease to distant sites

M1 – Spread of the disease to distant sites

What are the 4 Stages of Nasopharyngeal Cancer?

Based on the TNM classification discussed above, nasopharyngeal cancer is assigned a stage from I to IV.

STAGE TNM    
I T1 N0 M0    
II T2 N0-1 M0    
  T0-1 N1 M0    
III T3 N0-2 M0    
  T0-2 N2 M0    
IVA Any T N3 M0    
  T4 N0-2 M0    
IVB Any T Any N M1    

What is the Survival Rate/ Life Expectancy according to Stage of Nasopharyngeal Cancer?

Survival rates are calculated based on whether the disease is Localised, Regional or Distant.

Localised

  • Cancer is limited to the nasopharynx
  • 5 year survival 82%.

Regional

  • Cancer has spread to nearby structures or lymph nodes
  • 5 year survival 73%.

Distant

  • Cancer has spread to distant body parts.
  • 5 year survival 48%.

Treatment of Nasopharyngeal Cancer

Apart from the stage of disease, the selection of treatment usually depends upon the stage, performance status of the patient, along with other factors. Following are the preferred treatment approaches for different stages of nasopharyngeal cancer, but the final decision is taken after clinical assessment of the patient by an oncologist.

Non Metastatic disease treatment infographic

Stage I

For Stage I cancer, radiotherapy is considered as the preferred treatment. Prophylactic radiation treatment to nearby lymph nodes is also generally recommended to be employed as the primary treatment.

Stage II to IVA

For Stage II to IVA cancers (locoregionally advanced disease), a combination of radiotherapy and chemotherapy is usually employed as the first-line treatment. This may be followed by more chemotherapy to treat any remaining cancer cells. Chemotherapy may also be given first (induction therapy), followed by a combination of radiotherapy and chemotherapy.

Stage IVB

For Stage IVB cancer, chemotherapy, immunotherapy or targeted therapy are the treatment options. Radiation therapy may be employed as palliative treatment.

treatment for metastatic nasopharyngeal cancer

Hypopharyngeal Cancer

hypopharyngeal-cancer

TNM Staging

T STAGING

Tis – Carcinoma in situ or cancerous lesion is present only in the superficial layer of the hypopharynx.

T1 – The primary tumor is </=2 cm in size. T1, tumor less than 2 cm T2 – The primary tumor is >2 cm but </=4 cm in size. T2 - tumor 2 cm to 4 cm T3 – The primary tumor is >4 cm in size or has invaded into the lingual surface of the epiglottis. T3, tumor more than 4 cm T4a – The primary tumor has invaded any of the adjacent structure, such as larynx, hard palate, or mandible. T4a, invades thyroid cartilage T4a, invades cricoid cartilage T4a, invades hyoid bone T4b – The primary tumor of any size that has invaded a vital structure, such as pterygoid plates, lateral nasopharynx, or skull base and/or surrounds the carotid artery. T4b, encases carotid artery T4b, invades prevertebral fascia hypopharyngeal-cancer-T-staging

N STAGING

N0 – No spread of tumor to nearby lymph nodes

N1 – The disease has spread to a single ipsilateral lymph node measuring </=3 cm without extranodal involvement. N1 - single ipsilateral lymph node measuring </=3 cm N2a – The disease has spread to a single ipsilateral lymph node measuring >3 cm but </= 6cm N2a - single ipsilateral lymph node measuring >3 cm but </= 6cm N2b – Metastasis to multiple ipsilateral nodes, none >6 cm N2b - multiple ipsilateral nodes, none >6 cm N2c – Metastasis to bilateral/contralateral lymph nodes, all measuring <6 cm without extranodal involvement. N2c - bilateral/contralateral lymph nodes, all measuring <6 cm N3 – The disease has spread to lymph nodes measuring >6 cm or significant extranodal involvement. N3 - measuring >6 cm head and neck cancer N staging

M STAGING

M0 – No spread to distant body parts.

M1 – The disease has spread to a distant body parts

What are the 4 Stages of Hypopharyngeal Cancer?

Based on the TNM classification discussed above, hypopharyngeal cancer is assigned a stage from I to IV.

STAGE TNM    
0 Tis N0 M0    
I T1 N0 M0    
II T2 N0 M0    
III T3 N0 M0    
  T1-3 N1 M0    
IVA T1-3 N2 M0    
  T4a N0-2 M0    
IVB Any T N3 M0    
  T4b Any N M0    
IVC Any T Any N M1    

What is the Survival Rate/ Life Expectancy according to Stage of Hypopharyngeal Cancer?

Survival rates are calculated based on whether the disease is Localised, Regional or Distant.

Localised

  • Cancer is limited to the hypopharynx
  • 5 year survival 59%.

Regional

  • Cancer has spread to nearby structures or lymph nodes
  • 5 year survival 33%.

Distant

  • Cancer has spread to distant body parts.
  • 5 year survival 21%.

Treatment of Hypopharyngeal Cancer

Apart from the stage of disease, the selection of treatment usually depends upon the location of disease, patient’s preference, performance status of the patient, along with other factors. Following are the preferred treatment approaches for different stages of hypopharyngeal cancer, but the final decision is taken after clinical assessment of the patient by an oncologist. non metastatic disease treatment infographic

Stage 0

For Stage 0 cancers, surgical resection of the involved site is considered as the standard treatment. The patient should be followed-up closely after treatment for any sign of recurrence.

Stage I and II

For Stage I and II cancers, surgery is considered as the preferred treatment. Surgical resection of the involved site along with lymph node dissection is generally employed. Radiation therapy with or without chemotherapy may be employed after the primary treatment to kill any remaining cancer cells or in the presence of any adverse prognostic features. The patient should be followed-up closely after treatment for any sign of recurrence.

Stage III to IVA

For Stage III to IVA cancers, any of the following 3 approaches can be utilized as the preferred treatment: 1) Start treatment with chemotherapy alone (induction therapy) followed by radiation therapy or radiotherapy + chemotherapy based on the extent of tumor shrinkage with primary treatment. 2) Surgery is employed as the first-line treatment and involves the resection of the primary tumor along with any affected lymph nodes. This is followed by radiation therapy or radiotherapy + chemotherapy based on the presence of any adverse prognostic features. 3) Chemotherapy + radiotherapy or radiotherapy alone can be employed as the primary treatment. Surgery may be employed to remove any remnant cancer tissue.

Stage IVB

For Stage IVB cancer, radiotherapy along with chemotherapy is usually employed as the first-line treatment. Surgery may be employed if the tumor shrinks sufficiently that it can be removed with surgery. Radiation therapy may be employed as palliative treatment.

Stage IVC

For Stage IVC cancer, chemotherapy, immunotherapy or targeted therapy are the treatment options. Radiation therapy may be employed as palliative treatment. metastatic disease treatment infographic

Laryngeal Cancer (Voice Box Cancer)

TNM Staging

T STAGING

Tis – Carcinoma in situ or cancerous lesion is present only in the superficial laryngeal layer.

T1 – The primary tumor is limited to one part of the supraglottis with normal vocal cord movement.

T2 – The primary tumor is present in more than one part of the supraglottis/glottis with normal vocal cord movement.

T3 – The primary tumor is limited to the larynx with no movement in the vocal cord and/or it has invaded into the post-cricoid area, para-glottic space, pre-epiglottic space, or the inner part of the thyroid cartilage.

T4a – The primary tumor has invaded an adjacent structure, such as the outer cortex of the thyroid cartilage, trachea, strap muscles, thyroid, or esophagus.

T4b – The primary tumor that has invaded a vital structure, such as prevertebral space, mediastinal structure, or surrounds the carotid artery.

GLOTTIC LARYNX T STAGING

larynx glottic T1 to T3 Larynx glottic T4

SUPRAGLOTTIC LARYNX T STAGING

larynx supraglottic T1 to T3 larynx supraglottic T4

SUBGLOTTIC LARYNX T STAGING

Larynx subglottic T1 to T3 Larynx subglottic T4

N STAGING

N0 – No spread of tumor to nearby lymph nodes

N1 – The disease has spread to a single ipsilateral lymph node measuring </=3 cm without extranodal involvement. N1 - single ipsilateral lymph node measuring </=3 cm N2a – The disease has spread to a single ipsilateral lymph node measuring > 3 cm and </= 6 cm N2a - single ipsilateral lymph node measuring > 3 cm and </= 6 cm N2b – Metastasis to multiple ipsilateral nodes, none >6 cm N2b - multiple ipsilateral nodes, none >6 cm N2c – Metastasis to bilateral/contralateral lymph nodes, all measuring <6 cm without extranodal involvement. N2c - bilateral/contralateral lymph nodes, all measuring <6 cm N3 – The disease has spread to lymph nodes measuring >6 cm or significant extranodal involvement. N3 - lymph nodes measuring >6 cm head and neck cancer N staging

M STAGING

M0 – No spread to distant body parts

M1 – Disease has spread to distant body parts

What are the 4 Stages of Laryngeal Cancer?

Based on the TNM classification discussed above, laryngeal cancer is assigned a stage from I to IV.

STAGE TNM    
0 Tis N0 M0    
I T1 N0 M0    
II T2 N0 M0    
III T3 N0 M0    
  T1-3 N1 M0    
IVA T1-3 N2 M0    
  T4a N0-2 M0    
IVB Any T N3 M0    
  T4b Any N M0    
IVC Any T Any N M1    

What is the Survival Rate/ Life Expectancy according to Stage of Laryngeal Cancer?

Survival rates are calculated based on whether the disease is Localised, Regional or Distant.

For Supraglottic Cancer

5 year survival is as follows.

  • Localised Disease- 61%.
  • Regional Disease – 47%.
  • Distant Disease – 30%.

For Glottic Cancer

5 year survival is as follows.

  • Localised Disease- 83%.
  • Regional Disease – 48%.
  • Distant Disease – 42%.

For Subglottic Cancer

5 year survival is as follows.

  • Localised Disease- 60%.
  • Regional Disease – 33%.
  • Distant Disease – 45%.

Treatment of Laryngeal Cancer

Apart from the stage of disease, the selection of treatment usually depends upon the location of disease, patient’s preference, performance status of the patient, along with other factors. Following are the preferred treatment approaches for different stages of laryngeal cancer, but the final decision is taken after clinical assessment of the patient by an oncologist.

non metastatic disease treatment infographic

Stage 0

For Stage 0 cancers, endoscopic surgical resection of the involved tissue or radiotherapy is considered as the preferred treatment. The patient should be followed-up closely after treatment for any sign of recurrence.

Stage I and II

For Stage I and II cancers, radiotherapy is considered as the preferred treatment. Surgical resection (partial laryngectomy) may also be employed as the primary treatment.

Stage III to IVA

For Stage III to IVA cancers, any of the following 3 approaches can be utilized as the preferred treatment: 1) Start treatment with chemotherapy (induction therapy) followed by surgery or radiotherapy + chemotherapy 2) Surgical resection followed by radiation therapy or radiotherapy + chemotherapy based on the presence of any adverse prognostic features. 3) Chemotherapy + radiotherapy or radiotherapy alone can be employed as the primary treatment. Surgery may be employed to remove any remnant cancer tissue.

Stage IVB

For Stage IVB cancer, radiotherapy combined with chemotherapy or targeted therapy is usually employed as the first-line treatment. Palliative treatment to relieve symptoms may be employed, as appropriate.

Stage IVC

For Stage IVC cancer, chemotherapy, immunotherapy or targeted therapy are the  treatment options. Radiation therapy may be employed as palliative treatment.

metastatic disease treatment infographic

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