title: Challenges for the future modifications of the TNM staging system for head and neck cancer: case for a new computational model?
abstract: The TNM system of staging cancers is a simple and effective method to map the extent of tumours. It had traditionally strived to maintain a balance between being simple and user-friendly on one hand and comprehensive on the other. A number of revisions have taken place over the years with the goal of improving utility. However, numerous controversies surround the TNM system. There is a school of thought that contends that patient co-morbidity and specific tumour-related factors should be incorporated to add further prognostic capabilities in the TNM system, but this raises concerns that such an approach may unnecessarily complicate the system. This review highlights some controversies that surround the TNM system and suggests prognostic indicators that may be added to make it more useful in guiding treatment decisions and predicting outcomes.
authors.affiliation: Department of ENT and Head and Neck Surgery, Grant Medical College and Sir J.J. Group of hospitals. Mumbai 400 008, India. kapila.manikantan@gmail.com
authors.forename: Kapila
authors.initials: K
authors.lastname: Manikantan
authors.forename: Suhail I
authors.initials: SI
authors.lastname: Sayed
authors.forename: Konstantinos N
authors.initials: KN
authors.lastname: Syrigos
authors.forename: Peter
authors.initials: P
authors.lastname: Rhys-Evans
authors.forename: Chris M
authors.initials: CM
authors.lastname: Nutting
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Harrington
authors.forename: Rehan
authors.initials: R
authors.lastname: Kazi
mesh_terms: D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis