Chapter 1 - Epidemiology, Risk factors and Pathogenesis of Squamous Cell Tumours
Survival in HNSCC is predicted primarily by anatomical site, stage and HPV status, with other pathological and clinical factors influencing prognosis to a lesser degree.
In the recent EUROCARE population-based study, 5-year relative survival was poorest for hypopharyngeal cancer (25%) and highest for laryngeal cancer (59%).
For oral cavity and pharyngeal cancer, 31% of cases are localised at the time of diagnosis. For laryngeal cancer, 55% of patients are diagnosed with localised disease.
For oral cavity and pharyngeal cancer, 5-year survival rates have increased from 57% in 1992 to 65.1% in 2003. Death rates have not changed over 2003–2012.
For cancer of the larynx, 5-year survival rates have not changed significantly over the past 30 years.
The survival improvement is greatest for tonsil cancer (39.7% to 69.8%). This trend is attributed to HPV-positive tumour status, which is a strong predictor for survival.
High cure rates are reported for localised and locoregional disease. However, the 3-year survival rate does not exceed 40% in a subset of patients with localised HNSCC.
HPV-positive oropharyngeal cancer (OPC) patients show better response to treatment, and survival is improved by approximately 50%. Improvement in survival is reduced in smokers.
Despite advances in multimodality treatment, survival rates for recurrent/metastatic disease remain dismal.
Revision Questions
- What is the 5-year survival rate of head and neck cancer in Europe by anatomical site?
- What is the trend of survival rates for oral cavity and pharyngeal cancer and cancer of the larynx in the past 20 years?
- What is the 3-year survival rate of head and neck cancer according to stage?
