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Squamous cell carcinoma of the oral cavity (SCCOC) and squamous cell carcinoma of the oropharynx (SCCOP) represent two distinct disease entities.
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A clinical profile has emerged for the patient with an human papillomavirus (HPV)–associated SCCOP as typically a middle-aged, white male, without heavy tobacco history.
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The American Joint Committee on Cancer tumor, node, metastasis staging system has useful prognostic significance for SCCOC, but it does not include important prognostic histopathologic
Evaluation and Staging of Squamous Cell Carcinoma of the Oral Cavity and Oropharynx: Limitations Despite Technological Breakthroughs
Section snippets
Key points
Diagnosis and evaluation of SCCOC
SCCOC generally presents with a painful oral lesion, although other presenting symptoms include a painful or bleeding ulcer, loose teeth or ill-fitting dentures, trismus (caused by pterygoid involvement), hypoesthesia (caused by perineural involvement), or otalgia (referred pain from the ninth and 10th cranial nerves). Evaluation of SCCOC should include a thorough history and physical examination, dental evaluation, and cross-sectional imaging (CT or magnetic resonance imaging [MRI]). Tissue
Diagnosis and evaluation of SCCOP
Considerations in the diagnosis and evaluation of SCCOP have changed over the last decade because of the emergence of HPV, which now may account for greater than 80% of SCCOP in Western countries.4, 5 A clinical profile has emerged for the patient with an HPV-associated SCCOP as typically a middle-aged, white male, without a heavy tobacco history.6, 7, 8, 9 Patients with HPV-associated SCCOP often present with a painless neck mass that is often cystic on cross-sectional imaging and can be
Prognostic staging for SCCOC
The American Joint Committee on Cancer (AJCC) tumor, node, metastasis (TNM) staging system is a universally accepted, anatomically based clinical staging system for SCCOC (Table 1 summarizes the most recent seventh edition guidelines published in 2010).14 Kreppel and colleagues15 recently evaluated the sixth edition AJCC guidelines published in 2003, confirming that the T stage, N stage, and overall stage groupings remain good predictors of overall survival in patients with SCCOC (Fig. 2).
TNM Staging
The most recent AJCC staging guidelines for SCCOP remain almost identical to those for SCCOC (see Table 1). Although there is subtle difference in characterization of advanced primary tumors (T3 and T4) related to invasion of adjacent structures, the early primary tumor (T1 and T2), regional lymph nodes (N), distant metastasis (M), and anatomic stage/prognostic groups for these two distinct diseases are the same. As discussed earlier, the staging system for SCCOC has been validated in the
Sentinel Lymph Node Biopsy
Lymph node involvement has long been known as one of the most important prognostic indicators guiding treatment of SCCOC.38, 39 Approximately 30% of clinically and radiographically negative necks may harbor occult lymph node metastases,40, 41, 42 and therefore elective selective neck dissection has become the standard of care for many patients with SCCOC whose primary tumor depth of invasion places them at significant risk for occult lymph node metastases.41, 43 SNB has emerged over the last
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Cited by (12)
Pretreatment tumor volume and tumor sphericity as prognostic factors in patients with oral cavity squamous cell carcinoma
2019, Journal of Cranio-Maxillofacial SurgeryCitation Excerpt :The purpose of the tumor, node, metastasis (TNM) classification system is to facilitate the treatment planning, the prognosis, and the uniform assessment of treatment, results, and research (Shah and Gil, 2009; Kreppel et al., 2013). Despite being a user-friendly, universally applicable classification of tumor burden, the TNM system for OSCCs is based on maximum tumor length, which fails to take into account for the overall tridimensional extent of the tumor (Van der Schroeff et al., 2009; Zafereo, 2013). Indeed, small or superficial tumors (T1 or T2 stage) can especially be overestimated by the TNM classification, and would better fit into a classification based on a volumetric evaluation of the tumor size.
PET–Computed Tomography in Head and Neck Cancer: Current Evidence and Future Directions
2018, Magnetic Resonance Imaging Clinics of North AmericaCitation Excerpt :Combining FDG PET with contrast-enhanced CT, Krabbe and colleagues9 reported sensitivity and specificity of FDG PET-CT for detecting primary tumor of greater than 90%. Due to the spatial resolution of PET, small lesions of a few millimeters may not be detected, especially along superficial mucosal surfaces.11 This limitation in spatial resolution is compounded by physiologic FDG uptake in the head and neck, such as lymphoid tissues in Waldeyer ring, vocal cords, and muscles.
Tumor thickness and risk of lymph node metastasis in patients with squamous cell carcinoma of the tongue
2016, Oral OncologyCitation Excerpt :Although this role was confirmed in the present study, the TNM classification has some limitations. Despite being a user-friendly, universally applicable indicator of tumor burden, the TNM system for OSCCs is based on maximum tumor size only, which fails to account for the overall volume and thickness of the tumor [28,29]. Indeed, small or superficial tumors are at particular risk of being overestimated by the TNM classification, and might be underestimated in cases where critical tumor thickness spreads into lymph nodes [16,30].
<sup>68</sup>Ga-FAPI PET/CT: Tracer uptake in 28 different kinds of cancer
2019, Journal of Nuclear MedicineUpdate 2018: 18F-FDG PET/CT and PET/MRI in Head and Neck Cancer
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Disclosures: The author has no conflicts of interests to disclose.