Clinical Presentation and Work-Up of SCC of the Oral Tongue

  • Clinical presentation of oral tongue cancer:
    • Patients with oral cancer may present with several symptoms notably:
    • Pain
    • Ulceration
    • A lump on the tongue
  • Lesions of the oral tongue:
    • Are more likely to be symptomatic than lesions of the base of the tongue:
      • Although despite this many patients still present with a four- to six-month history of symptoms prior to seeking medical advice
    • The majority of patients with cancer of the oral tongue present with stage I / II disease:
      • Which contrasts significantly with cancers of the base of the tongue that are usually stage III / IV at presentation
    • Clinically positive cervical lymphadenopathy at presentation:
      • Is in the region of 21% to 34%:
        • Occult cervical metastasis has been demonstrated in up to 53% of patients with tongue cancer:
          • Being related to tumor thickness
        • Tumors arising on the lateral aspect of the tongue tend to be thicker than those of the ventral aspect of the tongue:
          • Up to 4.5% may have occult cervical disease in the contralateral neck
        • Clinical examination, CT and MRI:
          • Have relatively poor sensitivity at determining cervical lymph-adenopathy
  • The majority of tongue tumors:
    • Are well to moderately differentiated on histological examination
  • Work up:
    • As with many sites, management of the neck is frequently determined by tumor thickness:
      • Tumor thickness can be assessed accurately with intraoral sonography, or immediate sonography of the resected tumor:
        • Prior to proceeding to a neck dissection if access to the neck is not required for reconstructive purposes
    • Biopsies should endeavour to include the deep margin of the tumor in addition to mucosa at the periphery of the tumor:
      • Deep biopsies may give an indication of tumor depth:
        • But also multifactorial histological malignancy grading of the most dysplastic areas of the invasive front may help in assessing the risk of cervical metastasis
#Arrangoiz #CancerSurgeon #HeadandNeckSurgeon #SurgicalOncology #TongueCancer #MountSiniaMedicalCenter #MSMC #Miami #Mexico

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s