Oral cancer staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]; Grammar Reviewer: Natalie Harpenau, B.S.[3]

Overview

According to the TNM staging system by the American Joint Committee on Cancer, there are four stages of oral cancer based on the tumor size, lymph nodes involved and metastasis.

Staging

  • The staging systems are all clinical and based on the best possible estimate of the extent of disease before treatment.
  • Information from diagnostic imaging studies may be used in staging.
  • Magnetic resonance imaging offers an advantage over computed tomographic scans in the detection and localization of head and neck tumors and in the distinction of lymph nodes from blood vessels.
  • If a patient relapses, complete re-staging must be done to select the appropriate additional therapy.
  • The stage of the disease depends on several factors:
    • The size of the primary lesion
    • Local extension
    • Lymph node involvement
    • Evidence of distant metastasis
  • The tumor-node­ metastasis (TNM) classification of oral cancer is the most widely accepted system.
  • This system has 3 basic clinical features:
    • The size (in centimeters) of the primary tumor
    • The presence, number, size, and spread (unilateral or bilateral) to the local lymph nodes
    • The presence or absence of distant metastasis.

T Categories for oral cavity cancers

  • These measurements refer to the primary oral cancer tumor.
T Classification Thickness
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in-situ
T1 Tumor ≤ 2 cm in greatest dimension
T2 Tumor > 2 cm but ≤ 4 cm in greatest dimension
T3 Tumor > 4 cm in greatest dimension
T4a Moderately advanced local disease

(Lip) Tumor invades through cortical bone, inferior alveolar nerve, floor of mouth, or skin of face, that is, chin or nose.

(Oral cavity) Tumor invades adjacent structures only (e.g., through cortical bone [[[mandible]] or maxilla] into deep [extrinsic] muscle of tongue [[[genioglossus]], hyoglossus, palatoglossus, and styloglossus], maxillary sinus, or skin of face).

T4b Very advanced local disease

Tumor invades masticator space, pterygoid plates, or skull base and/or encases internal carotid artery

N Categories for oral cavity cancers

N Classification Nodal Mass
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in a single ipsilateral lymph node, ≤ 3 cm in greatest dimension
N2 Metastasis in a single ipsilateral lymph node, > 3 cm but ≤ 6 cm in greatest dimension

Metastases in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension

Metastases in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension

N2a Metastasis in single ipsilateral lymph node, > 3 cm but ≤ 6 cm in greatest dimension
N2b Metastases in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension
N2c Metastases in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension
N3 Metastasis in a lymph node > 6 cm in greatest dimension.

M Categories for Oral Cavity

M Classification Definition
M0 No evidence of distant metastasis
M1 Distant metastasis

Stages of Oral cancer

Stage T N M
0 Tis N0 M0
I T1 N0 M0
II T2b N0 M0
III T3 N0 M0
T1 N1 M0
T2 N1 M0
T3 N1 M0
IVA T4a N0 M0
T4a N1 M0
T1 N2 M0
T2 N2 M0
T3 N2 M0
T4a N2 M0
IVB AnyT N3 M0
T4b AnyN M0
IVC AnyT AnyN M1

Tumor grades of oral cancer

Tumor grading is recommended using Broder classification (Tumor Grade [G]):

Grade of Tumor(G) Definition
G1 Well-differentiated
G2 Moderately well-differentiated
G3 Poorly differentiated
G4 Undifferentiated

No statistically significant correlation between degree of differentiation and the biologic behavior of the cancer exists; however, vascular invasion is a negative prognostic factor.

References


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