Quality standard
Quality statement 2: Clinical staging
Quality statement 2: Clinical staging
Quality statement
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.
Quality measures
Structure
a) Evidence of local arrangements and written clinical protocols to ensure that people with N3 upper aerodigestive tract cancer are offered systemic staging using FDG PET-CT.
Data source: Local data collection.
b) Evidence of local arrangements and written clinical protocols to ensure that people with T4 cancers of the hypopharynx and nasopharynx are offered systemic staging using FDG PET-CT.
Data source: Local data collection.
Process
a) Proportion of people with N3 upper aerodigestive tract cancer who have systemic staging using FDG PET-CT.
Numerator – the number in the denominator who have systemic staging using FDG PET-CT.
Denominator – the number of people with N3 upper aerodigestive tract cancer.
Data source: Local data collection.
b) Proportion of people with T4 cancers of the hypopharynx and nasopharynx who have systemic staging using FDG PET-CT.
Numerator – the number in the denominator who have systemic staging using FDG PET-CT.
Denominator – the number of people with T4 cancers of the hypopharynx and nasopharynx.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers (head and neck cancer secondary and tertiary care services) have systems in place for people with N3 upper aerodigestive tract cancer or T4 cancers of the hypopharynx and nasopharynx to have systemic staging using FDG PET-CT.
Healthcare professionals (members of head and neck cancer multidisciplinary teams) offer systemic staging using FDG PET-CT to people with N3 upper aerodigestive tract cancer or T4 cancers of the hypopharynx and nasopharynx.
Commissioners (NHS England) ensure that they commission services which offer people with N3 upper aerodigestive tract cancer or T4 cancers of the hypopharynx and nasopharynx systemic staging using FDG PET-CT.
People with some cancers of the upper aerodigestive tract (the mouth, throat, voice box or sinuses) that are at an advanced stage are offered a scan to show where the cancer is and how far it has spread. This will mean that they can be offered the best treatment for them.
Source guidance
Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over. NICE guideline NG36 (2016, updated 2018), recommendations 1.2.9 and 1.2.10
Definitions of terms used in this quality statement
Specific advanced stage cancers of the upper aerodigestive tract
These are cancers of the upper aerodigestive tract with significant involvement of the lymph nodes by cancer cells (N3) and cancers of the hypopharynx (the area of the throat where the oesophagus and voice box meet) and nasopharynx (the air cavity lying at the back of the nose and above the roof of the mouth) where the primary tumour is significant in size (T4). [Adapted from NICE's guideline on cancer of the upper aerodigestive tract, recommendations 1.2.9 and 1.2.10 and expert opinion]
Equality and diversity considerations
Due to the availability of FDG PET-CT scanning, a few people with specific advanced stage cancers of the upper aerodigestive tract may need to travel a significant distance to undergo the scan. People needing this type of scan should be offered it irrespective of the distance they need to travel and should be supported to make the journey if necessary.