Squamous cell carcinoma of the head and neck: ESMO clinical Recommendations for diagnosis, treatment and follow-up.

Routine staging includes physical examination, chest X-ray, head and neck endoscopy, and head and neck CT scan or MRI. A thoracic CT scan may be carried out to rule out metastatic disease. Squamous cell head and neck cancer should be staged according to the TNM system and grouped into the following categories (Table). T4 tumors are subdivided into T4a resectable and T4b unresectable. Stage IV is subdivided into stages IVa and IVb accordingly, and stage IVc for metastatic disease.