TNM classification and disease description in head and neck cancer

The TNM concept is beset by frequent revisions, ambiguities, and incomplete coverage of tumor sites. A study comparing clinicians' classifications with computer-derived TNM classifications yielded discrepancies ranging from 44 per cent in T designations to 25 per cent in N designations, of which 35 per cent and 20 per cent, respectively, are ascribable to clinician error. To remedy these problems, it is proposed that clinicians record basic clinical data on standard forms covering the most relevant information. These forms can substitute for existing office and hospital records, thus avoiding added paperwork. TNM classification and staging may be subsequently generated from the recorded data. This two stage process affords the flexibility of applying common TNM systems for comparison of diverse clinical series while preserving the original basic data for alternative uses. Proposed data forms cover tumor characteristics, involved sites, palpable nodes, vocal cord mobility, nerve dysfunction, distant metastasis, and pretreatment diagnosis.