Staging of oral cavity cancer

The staging of primary tumors of the oral cavity as published by the American Joint Committee on Cancer/International Union Against Cancer is widely accepted.

• The surface dimensions and local extent of the tumor are the most important parameters for primary tumor staging in the oral cavity.

• One glaring deficiency of this staging system is the lack of the depth of infiltration of the tumor as a parameter for staging.

• However, accurately assessing the tumor depth clinically is difficult:

  • Deeply infiltrating primary tumors have an increased risk of regional metastases and death due to disease compared with superficial tumors of the same T stage.

  • Thus a more aggressive therapeutic approach, including elective treatment of regional lymph nodes, should be considered for patients with early T-staged but deeply infiltrating tumors.

  • On the other hand, advanced T-staged but relatively superficial lesions have a better prognosis.

The depth of infiltration of the primary tumor as a parameter for staging has been added in the new 8th edition of the AJCC staging system:

Tx – Primary tumor cannot be assessed

Tis – Carcinoma in situ

T1 – Tumor < 2 cm, < 5 mm depth of invasión (DOI).
= DOI is depth of invasión and not tumor thickness.

T2 – Tumor < 2 cm, DOI > 5 mm and < 10 mm
or tumor > 2 cm but < 4 cm, and < 10 mm DOI

T3 – Tumor > 4 cm or any tumor > 10 mm DOI

T4 – Moderately advanced or very advanced local disease

T4a – Moderately advanced local disease

= (Lip) Tumor invades through cortical bone or involves the inferior alveolar nerve, floor of mouth, or skin of face (i.e., chin or nose)

= (Oral cavity) Tumor invades adjacent structures only (e.g., through cortical bone of the mandible or maxilla, or involves the maxillary sinus or skin of the face)

Note: Superficial erosión of bone/tooth socket (alone) by a gingival primary is not sufficient to classify a tumor as T4.

T4b – Very advanced local disease
Tumor invades masticator space, pterygoid plates, or skull base and/or encases the internal carotid artery

The stage distribution of patients with squamous cell carcinoma of the oral cavity is shown in the figure:

Rodrigo Arrangoiz MS, MD, FACS a head and neck surgeon and is a member of Sociedad Quirúrgica S.C at the America British Cowdray Medical Center.

He is first author on some publications on oral cavity cancer:

• Understand Cancer: Research and Treatment Oral Cavity Cancer: Literature Review and Current Management. 

  • https://www.researchgate.net/publication/303366031_Understand_Cancer_Research_and_Treatment_Oral_Cavity_Cancer_Literature_Review_and_Current_Management

 

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016