Evaluation and Staging of Squamous Cell Carcinoma of the Oral Cavity and Oropharynx: Limitations Despite Technological Breakthroughs

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Key points

  • Squamous cell carcinoma of the oral cavity (SCCOC) and squamous cell carcinoma of the oropharynx (SCCOP) represent two distinct disease entities.

  • 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.

  • 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

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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    Disclosures: The author has no conflicts of interests to disclose.

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