Biological staging of head and neck cancer and its role in developing effective treatment strategies.

The purpose of a cancer staging system is to encompass all attributes of a tumor that define its life history. We propose a biological staging system which incorporates all of the phases of the natural history of head and neck cancer beginning with the earliest cellular changes extending through the early phase of invasion to the occurrence of metastasis and, finally, culminating in therapeutically refractory disease. This temporally structured system recognizes the importance of constitutional predisposition, and the impact of environmental factors. The intent is to augment the AJCC/UICC staging system and use this system to provide a framework which will easily incorporate current and future advances in basic science, prevention, therapy and palliation which will improve the quality and quantity of life for patients.