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

#### Summary points 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. ### 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, …