Tongue cancer staging: Difference between revisions

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{{CMG}}{{AE}}{{Simrat}}
{{CMG}}{{AE}}{{Simrat}}
==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]].<ref name="radio">  Sqamous cell carcinoma of the tongue. Radiopedia(2015) http://radiopaedia.org/articles/squamous-cell-carcinoma-of-the-tongue Accessed on November 17, 2015</ref><ref name="radio1"> Staging of Sqamous cell carcinoma of the oral cavity. Radiopedia(2015) http://radiopaedia.org/articles/staging-of-squamous-cell-carcinoma-of-the-oral-cavity Accessed on November 17, 2015</ref>
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]].<ref name="radio">  Sqamous cell carcinoma of the tongue. Radiopedia(2015) http://radiopaedia.org/articles/squamous-cell-carcinoma-of-the-tongue Accessed on November 17, 2015</ref><ref name="radio1"> Staging of Sqamous cell carcinoma of the oral cavity. Radiopedia(2015) http://radiopaedia.org/articles/staging-of-squamous-cell-carcinoma-of-the-oral-cavity Accessed on November 17, 2015</ref>
==Staging==
==Staging==
A common staging system is used for all [[squamous cell carcinomas]] of the [[oral cavity]], with [[tumor]] staging being based on size and extension into adjacent structures. Nodal staging is the same as that used for squamous cell carcinomas of the [[oral cavity]], [[oropharynx]], [[hypopharynx]] and [[larynx]].<ref name="radio">  Sqamous cell carcinoma of the tongue. Radiopedia(2015) http://radiopaedia.org/articles/squamous-cell-carcinoma-of-the-tongue Accessed on November 17, 2015</ref><ref name="radio"> Staging of Sqamous cell carcinoma of the oral cavity. Radiopedia(2015) http://radiopaedia.org/articles/staging-of-squamous-cell-carcinoma-of-the-oral-cavity Accessed on November 17, 2015</ref>
A common staging system is used for all [[squamous cell carcinomas]] of the [[oral cavity]], with [[tumor]] staging being based on size and extension into adjacent structures. Nodal staging is the same as that used for squamous cell carcinomas of the [[oral cavity]], [[oropharynx]], [[hypopharynx]] and [[larynx]].<ref name="radio">  Sqamous cell carcinoma of the tongue. Radiopedia(2015) http://radiopaedia.org/articles/squamous-cell-carcinoma-of-the-tongue Accessed on November 17, 2015</ref><ref name="radio"> Staging of Sqamous cell carcinoma of the oral cavity. Radiopedia(2015) http://radiopaedia.org/articles/staging-of-squamous-cell-carcinoma-of-the-oral-cavity Accessed on November 17, 2015</ref>
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*Level II nodes: upper jugulodigastic nodes
*Level II nodes: upper jugulodigastic nodes
*Potentially drain directly to level IV nodes  
*Potentially drain directly to level IV nodes  
*Posterior tongue: level II nodes (upper [[jugulodigastic]] nodes)
*Posterior tongue: level II nodes (upper jugulodigastic nodes)
It is important to remember that significant lymphatic drainage occurs across the midline, and thus the nodes of both sides of the neck need to be carefully examined for presence of nodal metastases. The incidence of [[lymph node]] [[metastases]] correlates with tumor thickness, which is best assessed on coronal images
It is important to remember that significant lymphatic drainage occurs across the midline, and thus the nodes of both sides of the neck need to be carefully examined for presence of nodal metastases. The incidence of [[lymph node]] [[metastases]] correlates with tumor thickness, which is best assessed on coronal images


Revision as of 18:25, 3 December 2015

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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]

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.[1][2]

Staging

A common staging system is used for all squamous cell carcinomas of the oral cavity, with tumor staging being based on size and extension into adjacent structures. Nodal staging is the same as that used for squamous cell carcinomas of the oral cavity, oropharynx, hypopharynx and larynx.[1][1] Whether CT or MRI is used the same features should be assessed:

  • Size of tumor and tumour thickness
  • Extension across the midline
  • Extension beyond the intrinsic muscles of the tongue
  • Involvement of adjacent structures

T Categories for tongue cancer
T Classification Thickness
TX
 Primary tumor cannot be assessed
T0
 No evidence of a 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) b
T4b
 Very advanced local disease.
  • Tumor invades masticator space, pterygoid plates, or skull base and/or encases internal carotid artery

b Mucosal extension to lingual surface of epiglottis from primary tumors of the base of the tongue and vallecula does not constitute invasion of larynx.

N Categories for tongue cancer b

Lymphatic drainage of the tongue is extensive, accounting presumably for the high rate of nodal metastases present at the time of diagnosis. Drainage patterns depend on the location of the primary lesion:

  • Level II nodes: upper jugulodigastic nodes
  • Potentially drain directly to level IV nodes
  • Posterior tongue: level II nodes (upper jugulodigastic nodes)

It is important to remember that significant lymphatic drainage occurs across the midline, and thus the nodes of both sides of the neck need to be carefully examined for presence of nodal metastases. The incidence of lymph node metastases correlates with tumor thickness, which is best assessed on coronal images

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

b Metastases at level VII are considered regional lymph node metastases

M Categories for tongue cancer
M Classification Definition
M0
 No distant metastasis
M1
 Distant metastasis

Stages of tongue cancer
Stage T N M
Stage 0
  • Tis
  • N0
  • M0
Stage I
  • T1
  • N0
  • M0
Stage II
  • T2b
  • N0
  • M0
Stage III
  • T3
  • T2
  • T1
  • T3
  • N0
  • N1
  • N1
  • N1
  • M0
  • M0
  • M0
  • M0
Stage IVA
  • T4a
  • T4a
  • T1
  • T2
  • T3
  • T4a
  • N0
  • N1
  • N2
  • N2
  • N2
  • N2
  • M0
  • M0
  • M0
  • M0
  • M0
  • M0
Stage IVB
  • Any T
  • T4b
  • N3
  • Any N
  • M0
  • M0
Stage IVC
  • Any T
  • Any N
  • M1

References

  1. ↑ 1.0 1.1 1.2 Sqamous cell carcinoma of the tongue. Radiopedia(2015) http://radiopaedia.org/articles/squamous-cell-carcinoma-of-the-tongue Accessed on November 17, 2015
  2. ↑ Staging of Sqamous cell carcinoma of the oral cavity. Radiopedia(2015) http://radiopaedia.org/articles/staging-of-squamous-cell-carcinoma-of-the-oral-cavity Accessed on November 17, 2015
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