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{{Oral cancer}}
{{Oral cancer}}
{{CMG}};{{AE}}{{Simrat}}
{{CMG}}; {{AE}} {{Simrat}}; {{GRR}} {{Nat}}
==Overview==
==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.
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==
==Staging==
The staging systems are all clinical staging and are based on the best possible estimate of the extent of disease before treatment. The assessment of the primary tumor is based on inspection and palpation when possible and by both indirect mirror examination and direct endoscopy when necessary. The tumor must be confirmed histologically, and any other pathologic data obtained on biopsy may be included. The appropriate nodal drainage areas are examined by careful palpation. 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 restaging must be done to select the appropriate additional therapy.
* The [[staging]] systems are all clinical and based on the best possible estimate of the extent of disease before treatment.
The stage of the disease depends on several factors:
* Information from diagnostic imaging studies may be used in staging.
*The size of the primary lesion
* [[Magnetic resonance]] imaging offers an advantage over [[Computed tomographic imaging|computed tomographic scans]] in the detection and localization of [[Head and neck cancer|head and neck tumors]] and in the distinction of [[lymph nodes]] from [[blood vessels]].
*Local extension
* If a patient relapses, complete re-staging must be done to select the appropriate additional therapy.
*Lymph node involvement
* The stage of the disease depends on several factors:
*Evidence of distant metastasis.
** The size of the primary lesion
The tumor-node­ metastasis (TNM) classification of oral cancer is most widely accepted protocol. This system has 3 basic clinical features:  
** Local extension
*The size (in centimeters) of the primary tumor
** [[Lymph node]] involvement
*The presence, number, size, and spread (unilateral or bilateral) to the local lymph nodes
** Evidence of distant [[metastasis]]
*The presence or absence of distant metastasis.<ref>{{Cite web | title =NIH Oral cancer staging| url =http://www.cancer.gov/types/head-and-neck/hp/lip-mouth-treatment-pdq#section/_18 }}</ref>
 
===T Categories for Oral Cavity===
* The tumor-node&shy; 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.
*These measurements refer to the primary oral cancer tumor.
{| {{table}}
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
! style="background: #4479BA;" | {{fontcolor|#FFF|'''T Classification'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''T Classification'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Thickness'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Thickness'''}}
|-
|-
| TX||Primary tumor cannot be assessed
| TX||[[Primary tumor]] cannot be assessed
|-
|-
| T0||No evidence of primary tumor
| T0||No evidence of [[primary tumor]]
|-
|-
| Tis|| Carcinoma in situ
| Tis|| [[Carcinoma in situ|Carcinoma in-situ]]
|-
|-
| T1||Tumor ≤2 cm in greatest dimension.
| T1||[[Tumor]] ≤ 2 cm in greatest dimension
|-
|-
| T2||Tumor >2 cm but ≤4 cm in greatest dimension.
| T2||[[Tumor]] > 2 cm but ≤ 4 cm in greatest dimension
|-
|-
| T3||Tumor >4 cm in greatest dimension.
| T3||[[Tumor]] > 4 cm in greatest dimension
|-
|-
| T4a||Moderately advanced local disease.
| 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.
(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).
([[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.
|-
|-
| T4b||Very advanced local disease
[[Tumor]] invades masticator space, [[Pterygoid plate|pterygoid plates]], or skull base and/or encases [[internal carotid artery]]
|}
|}
===N Categories for Oral Cavity===
===N Categories for oral cavity cancers===
{| {{table}}
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
! style="background: #4479BA;" | {{fontcolor|#FFF|'''N Classification'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''N Classification'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Nodal Mass'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Nodal Mass'''}}
|-
|-
| NX||Regional lymph nodes cannot be assessed
| NX||Regional [[lymph nodes]] cannot be assessed
|-
|-
| N0||No regional lymph node metastasis
| N0||No regional [[lymph node]] [[metastasis]]
|-
|-
| N1||Metastasis in a single ipsilateral lymph node, ≤3 cm in greatest dimension
| 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.
| 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 multiple [[ipsilateral]] [[lymph nodes]], none > 6 cm in greatest dimension


Metastases in bilateral or contralateral 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
| 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
| 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.
| 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.
| N3||[[Metastasis]] in a [[lymph node]] > 6 cm in greatest dimension.
|}
|}


===M Categories for Oral Cavity===
===M Categories for Oral Cavity===
{| {{table}}
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
! style="background: #4479BA;" | {{fontcolor|#FFF|'''M Classification'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''M Classification'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Definition'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Definition'''}}
|-
|-
| M0||No evidence of distant metastasis
| M0||No evidence of distant [[metastasis]]
|-
|-
| M1||Distant metastasis
| M1||Distant [[metastasis]]
|}
|}
===Stages of Oral cancer===
===Stages of Oral cancer===
{| {{table}}
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Stage'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Stage'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''T'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''T'''}}
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|}
|}


===Tumor grades of oral cancer===
* Most [[head]] and [[neck]] cancers are of the [[squamous cell]] variety and may be preceded by various [[precancerous]] lesions.
* Minor [[Salivary gland tumor|salivary gland tumors]] are not uncommon in these sites.
* Specimens removed from the lesions may show the carcinomas to be non-invasive, in which case the term [[carcinoma in situ|carcinoma in-situ]] is applied.
* An invasive [[carcinoma]] will be well-[[Differentiate|differentiated]], moderately well-[[Differentiate|differentiated]], poorly [[Differentiate|differentiated]] or undifferentiated.


===Tumor Grades of Oral cancer===
[[Tumor]] grading is recommended using Broder classification (Tumor Grade [G]):
Most head and neck cancers are of the squamous cell variety and may be preceded by various precancerous lesions. Minor salivary gland tumors are not uncommon in these sites. Specimens removed from the lesions may show the carcinomas to be noninvasive, in which case the term carcinoma in situ is applied. An invasive carcinoma will be well differentiated, moderately well-differentiated, poorly differentiated or undifferentiated.
 
Tumor grading is recommended using Broder classification (Tumor Grade [G]):


{| {{table}}
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Grade of Tumor(G)'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Grade of Tumor(G)'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Definition'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Definition'''}}
|-
|-
| G1||Well differentiated
| G1||Well-[[Differentiation|differentiated]]
|-
|-
| G2||Moderately well differentiated
| G2||Moderately well-[[Differentiation|differentiated]]
|-
|-
| G3||Poorly differentiated
| G3||Poorly [[Differentiation|differentiated]]
|-
|-
| G4||Undifferentiated  
| 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.
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==
[[Category:Oral and maxillofacial surgery]]
[[Category:Otolaryngology]]
[[Category:Types of cancer]]
[[Category:Disease]]
[[Category:Mature chapter]]
 
 
{{WH}}
{{WS}}
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Otolaryngology]]
[[Category:Gastroenterology]]
[[Category:Surgery]]
<references />

Latest revision as of 12:51, 11 April 2019

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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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