Clinical Review

Head and neck cancer—Part 2: Treatment and prognostic factors

BMJ 2010; 341 doi: (Published 28 September 2010) Cite this as: BMJ 2010;341:c4690
  1. H Mehanna, director and honorary associate professor1,
  2. C M L West, professor of radiation biology2,
  3. C Nutting, director3,
  4. V Paleri, consultant surgeon and honorary clinical senior lecturer4
  1. 1Institute of Head and Neck Studies and Education, University Hospitals Coventry, Coventry CV2 2DX
  2. 2University of Manchester, Manchester
  3. 3Head and Neck Unit, Royal Marsden NHS Foundation Trust, London
  4. 4Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne
  1. Correspondence to: H Mehanna hishammehanna{at}

    Summary points

    • The main prognostic factors are stage, site of disease, and comorbidities

    • Treatment decisions should involve a multidisciplinary team of health professionals and the patient, and must balance efficacy and survival with potential functional and quality of life outcomes

    • Early stage cancers are usually treated by either surgery or radiotherapy

    • More advanced tumours usually require both surgery and chemoradiotherapy

    • The disease and its treatments can cause substantial functional impairment and reduced quality of life

    • Patients and their carers need considerable support during and after treatment

    In this second of a two part series, we discuss recent advances in the management of cancers of the head and neck. We also discuss the important prognostic factors, including the importance of human papillomavirus (HPV) positivity in the newly discovered HPV related cancers of the head and neck. As before, we have used evidence from national guidelines, randomised trials, and level II-III studies. We have also limited our discussions to squamous cell carcinoma of the head and neck, which constitutes more than 85% of head and neck cancers.

    Sources and selection criteria

    We used the terms “head and neck”, “larynx”, “oral”, and “oropharynx”—with each limited by “cancer”, “diagnosis”, and “treatment” separately—to search the Medline, Embase, PubMed, Cochrane, CINAHL, and AMED databases. We also used them to cross check national guidelines, reference lists, textbooks, and personal reference lists. We assessed over 1000 identified abstracts for relevance.

    What determines prognosis in head and neck cancer?

    Site and TNM stage

    The most important prognostic factors are site and TNM (tumour, node, metastasis) stage. The table details the survival rates of patients diagnosed with head and neck cancer at different sites. Patients with tumours that are larger and have spread to nodes and other tissues have poorer survival. Guidelines for head and neck carcinomas from the Royal College of Pathologists state that other accepted features related to clinical outcome are grade, pattern of invasion, …

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