New Staging System on Horizon for Head and Neck Cancers

The American Joint Committee on Cancer (AJCC) has announced a new edition of its staging manual for head and neck cancers. The revisions include sweeping changes in the classifications of some head and neck cancers and are scheduled to go into effect on January 1, 2018.

Dennis Kraus, MD, director of the Center for Head and Neck Oncology at the New York Head and Neck Institute in New York City, reviewed the update during a panel session at the Annual Meeting of the Triological Society. The changes are most dramatic in mucosal melanoma, oropharyngeal cancer, cancer with an unknown primary, and cancer of the oral cavity, he said.

The panel discussion also touched on robotic surgery and on the role of checkpoint inhibitors in head and neck cancer.

Changes to Cancer Staging

A main driver of the changes to the AJCC system was the goal to make staging a better tool for communicating with patients about their survival prospects, he said. “The concept is that we want to give any individual the actual likelihood of survival for their cancer,” he said. Those drafting the changes also wanted to refine the staging so that there would be a similar number of patients in each group, or roughly 25% in each of the four stages, he said.

Colored scanning electron micrograph (SEM) of squamous cell carcinoma cells from a human mouth.
© CNRI / Science Source

Another goal in making the changes is to distinguish each subgroup’s survival rates from those above and below it, he said. The changes also strive for worldwide acceptance and are meant to be applicable regardless of the resources of a center or provider, Dr. Kraus added.

Oropharyngeal cancer: Dr. Kraus said this is the category that has been updated the most. “One of the most notable changes—not just in the head and neck changes, but literally in this entire 600-page tome—are the changes that have been made in oropharyx cancer,” he said. Under the new system, only patients with metastatic disease will be considered stage IV. That’s because, when looking at three-year overall survival, stages I through III were grouped together fairly tightly, with “almost no statistical significance,” he said.

He added that, under the previous edition of the staging manual, the majority of patients were classified as having stage IV disease. “There’s poor balance, there’s poor hazard discrimination, and this was a must-fix for the current group,” he said. “We’ve made the obvious changes. We’ve separated oropharynx from hypopharynx. We have separate staging both for clinical and pathologic staging. And, interestingly, it’s very similar to nasopharynx disease, which has some overlap.”