Most published papers now adhere to the International Union Against Cancer (UICC) or the American Joint Committee on Cancer (AJCC) in staging method and result reporting. However, the literature rarely details the techniques used to stage the tumour. Surgical en bloc resection would be expected to provide definitive tumour staging; however, surgical specimens are subject to shrinkage artefact and errors of orientation. Recent trans-oral laser microsurgical techniques can also provide difficulties with pathological staging due to the piecemeal resection procedure and resultant multiple specimens generated. Staging of tumours treated with non-surgical techniques; do not have the benefit of cross-referencing clinical staging with pathological staging.
Staging by imaging is subject to inaccuracies, being relatively insensitive to superficially spreading upper aerodigestive tract mucosal tumours [1]. CT scanning is also thought to under-stage diseases in some subsites and MRI over-stage tumours in some subsites [2]. The traditional panendoscopy provided detailed visual and palpation evidence of tumour extent. When coupled with awake fibre-optic laryngopharyngosopy, dynamic assessment was added – essential in staging laryngeal disease. There is even evidence to suggest that videostroboscopy has a role to play in tumour staging [3]. The recent move towards fibre-optic evaluation only, might risk losing some of the detailed information gained by a full panendoscopy under general anaesthesia [4], although detailed comparative studied have not been performed to answer this question. Two modern additions to the panenedoscopy- use of the operating microscope and the Hopkin's rod rigid telescope system (with straight and angled lenses) have been shown to change staging [5, 6].
In our institution we use the schema in Appendix 1 for staging head and neck cancers. The panendoscopy has the elements described in Appendix 2. Imaging and pathological reporting is performed to the recommendations of the Scottish Intercollegiate Guidelines Network (SIGN) guidelines on the diagnosis and management of head and neck cancer [7].
