Learning About Your Diagnosis

If you have recently been diagnosed with head and neck cancer, then your health care professional probably obtained the results from your biopsy. Other pieces of information that your doctor also collected (or will soon gather) include the grade, histology subtype and stage. Let’s first briefly review what these tests and evaluations are and what they will tell you.

Biopsy, grade, histological subtype and stage

  • Biopsy:A biopsy is the removal of a small piece of tissue to examine under a microscope to see if it is cancerous. At some point, you will need a biopsy of any lesion your doctor suspects may be cancer. The biopsy report is extremely important for determining your diagnosis and treatment plan.
  • Grade: The pathologist will also grade the cells or categorise 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 will range from 1 to 4. If the cells appear normal, then they are categorised 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.
  • 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 tumour and how extensive it is within the body. The staging system used is based on tumour size (T) and how extensive the tumour is within the body; for example, whether the malignancy has entered regional lymph nodes (N), or whether the cancer has moved (metastasized) to distant sites within the body (M), such as the lungs.
  • Evaluating how extensive the tumour is within the body involves the use of imaging devices, such as computed tomography (CT), magnetic resonance imaging (MRI) or positron emission tomography (PET).

The types of stages are typically from an early stage (I), with the smallest tumour size that has not yet extended to lymph nodes or distant sites in the body, to stage (IV), which is either the largest tumour size or it has moved to distant sites in the body. Specifics are defined in each tumour subsite section of the Head and Neck Cancer Guide.

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 your diagnosis means: prognosis

Your health care provider should have provided you with 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 probable outcome of your cancer, which includes the likelihood of survival.

People who are 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 (82.4 percent) 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 (71.4 percent) chance of achieving a cancer-free state.

The grade is also related to prognosis; if a patient has cells that appear very abnormal (grade 4), he or she usually has a worse prognosis than a patient with very normal-appearing cells (grade 1).

What your diagnosis means: likely treatment course

Numerous clinical studies, which included patients with head and neck cancer, have been conducted. A panel of specialists has evaluated the findings from these clinical studies and recommended which treatments are likely to be most beneficial for subsets of patients.

Your health care professional will use your specific diagnosis and stage to provide a recommendation for the best treatment course for your cancer. In some cases, either the grade and/or the histological subtype (e.g., squamous cell or another type) will also be used to make a treatment recommendation.

It should be cautioned that although the diagnosis and stage are used to provide a recommendation for a treatment course, it does not mean that this is your only treatment option. Often, there are several possible treatment options. In addition, you have the right to evaluate the available information and decide whether it is the best treatment course for you. For example, sometimes patients refuse to have surgery and are instead treated with chemotherapy, radiation therapy or both.

Re-evaluation: should you get a second opinion?

Patients should be treated by a multidisciplinary team; the team members should have an expertise in head and neck cancer. Moreover, a study demonstrated that specialists versus non-specialists performed more accurate diagnoses. An accurate diagnosis is essential to select the best treatment option.

Head and neck cancers represent about 3.4 percent of all cancers in Australia, so it is uncommon. A hospital in a rural area, for example, may not have health care professionals with a high volume of head and neck cancer patients, which could potentially result in an inaccurate diagnosis and could in turn result in the selection of a less optimal treatment management plan.

You may want to consider identifying medical facilities that have specialists with an expertise in head and neck cancer to receive a second opinion.