In March 2017, NICE published a quality standard [QS146] in head and neck cancer. This quality standard covers assessing, diagnosing and managing head and neck cancer, including cancer of the upper aerodigestive tract, in young people (aged 16 and 17) and adults (aged 18 and over). It describes high-quality care in priority areas for improvement.
A term cancer of the upper aerodigestive tract encompasses cancers arising at different sites in the airways of the head and neck. These include cancers of the oral cavity, oropharynx, nasopharynx, hypopharynx, larynx and nasal sinuses.
This quality standard is endorsed by NHS England as required by the Health and Social Care Act (2012).
NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. NICE quality standards draw on existing NICE or NICE-accredited guidance that provides an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement.
Statement 1: People with cancer of the upper aerodigestive tract have their nutritional status, including the need for a prophylactic tube, assessed at diagnosis.
Rationale: Many people with cancer of the upper aerodigestive tract lose a lot of weight as a result of the disease and its treatment; they often have difficulty eating. Assessing their nutritional status, including their need for a prophylactic tube, at the time of diagnosis will help to ensure adequate nutrition before, during and after treatment. This in turn will maximise the chances of people with cancer of the upper aerodigestive tract completing curative treatment.
Statement 2: People with specific advanced stage cancers of the upper aerodigestive tract are offered systemic staging using fluorodeoxyglucose positron emission tomography (FDG PET)-CT.
Rationale: FDG PET-CT is more accurate for systemic staging than CT alone and shows if the cancer has spread beyond the primary site. More accurate staging will mean more appropriate treatment for specific advanced stage cancers. This will mean that people needing palliative treatment for disease spread will not have to undergo treatments with curative intent from which they will not benefit.
This quality statement concerns proportion of patient with N3 upper aerodigestive tract cancer and proportion of patients with T4 cancers of the hypopharynx and nasopharynx who have systemic staging using FDG PET-CT.
Statement 3: People with early stage oral cavity cancer who do not need cervical access as part of surgical management are offered sentinel lymph node biopsy as an alternative to elective neck dissection.
Rationale: Sentinel lymph node biopsy for early stage oral cavity cancer can mean that elective neck dissection is avoided in those patients who do not need it. This means a quicker recovery time, less time in hospital and avoiding the significant morbidity (neuropathic pain and reduced shoulder movement) associated with elective neck dissection.
Early stage oral cavity cancer is a cancer of the mouth which is staged as T1-T2, N-0.
Statement 4: People with cancer of the upper aerodigestive tract are given the choice of either radiotherapy or surgery if both are suitable options for their type of cancer.
Rationale: People with cancers of the upper aerodigestive tract that have similar outcomes from radiotherapy and surgery should be told that both of these treatments are available and what they involve. This should include details of the potential side effects (including late effects). Clear explanation and support from healthcare professionals should help people with cancers of the upper aerodigestive tract to make a fully informed choice of treatment based on their preference and should increase patient satisfaction.
Cancers of the upper aerodigestive tract for which radiotherapy or surgery are suitable options are:
- newly diagnosed T1b–T2 squamous cell carcinoma of the glottic larynx
- newly diagnosed T1–T2 squamous cell carcinoma of the supraglottic larynx
- T1–2 N0 tumours of the oropharynx
- T3 squamous cell carcinoma of the larynx.