Oral Cancer Staging

[DrTacoElf]

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Is oral cancer staging in terms of lymph nodes based on clinical or radiographic findings?

For instance if you have a T2 scc (greater than 2cm but less than 4cm) on the lateral border of the tongue without any palpable lymph nodes and you get a CT Neck which does show an enlarged lymph node in level II does this automatically make the patient T2N1 and therefore a stage III instead of T2N0 stage II.

Thanks for the help

 

[OtoHNS]

Is oral cancer staging in terms of lymph nodes based on clinical or radiographic findings?

For instance if you have a T2 scc (greater than 2cm but less than 4cm) on the lateral border of the tongue without any palpable lymph nodes and you get a CT Neck which does show an enlarged lymph node in level II does this automatically make the patient T2N1 and therefore a stage III instead of T2N0 stage II.

Thanks for the help

You need to factor both the physical exam as well as the radiologic images into the clinical staging of a cancer. Metastatic lymph nodes are generally not subtle, so if there is a truly enlarged node (i.e. >1 cm), you should be able to feel it.

You can also look at the imaging- benign reactive nodes are usually smooth and oblong. Malignant nodes usually show central necrosis.

It's ok to be uncertain- you can never know for certain unless you have a specimen for the pathologist.

Your hypothetical patient should get a neck dissection whether or not the node is positive, so you'll find out the pathologic staging either way.

 

[allENTmd]

Is oral cancer staging in terms of lymph nodes based on clinical or radiographic findings?

For instance if you have a T2 scc (greater than 2cm but less than 4cm) on the lateral border of the tongue without any palpable lymph nodes and you get a CT Neck which does show an enlarged lymph node in level II does this automatically make the patient T2N1 and therefore a stage III instead of T2N0 stage II.

Thanks for the help

As you add testing you update your staging. So the answer is yes, even though you did not palpate the nodes that are apparent on the CT you use this data to create the staging.

 

[HighPriest]

Yeah there is clinical staging, radiographic staging, and pathology staging. You’re always going to go with whatever upstages, with the understanding that path is the gold standard.

Same thing would be true if you thought the primary was 2cm and the imaging showed deep infiltration.

Or with staging system that depends upon subsites, sometimes you can’t tell until you get images.