Chapter 12 - Oral Cavity, Oropharynx

Question 1

Where OC and OP CAs spread

Answer 1

OC: LN I-III (supraomohyoid)
OP: LN II-IV, retroph, paraph

Question 2

General T staging criteria OC/OP

Answer 2

1: 0-2cm
2: 2-4cm
3: >4cm
4: extension to adjacent structures

Question 3

Basic, main difference between Tx of OC/OP CA

Answer 3

OC: Surgery
OP: Rads

Question 4

% of OC CAs that are SCC

Answer 4

90

Question 5

CAs in OC other than SCC

Answer 5

Minor salivary (hard palate, adenoid cystic)
Kaposi or other sarcoma
melanoma
lymphoma

Question 6

Most common SCC sites OC

Answer 6

1. Lips (15-30%), low (>90%)

2. Oral tongue (20-30%), lateral > dorsal

Question 7

Leukoplakia

Answer 7

white plaque/patch
cannot be rubbed off
chronic trauma/irritation
always bx, tough to predict transformation, then f/u or excise based on path

Question 8

Erythroplakia

Answer 8

red plaque, not from obvious mechanical/inflammatory cause
7x more malignant potential than leuko
complete excision, margins

Question 9

Oral lichen planus

Answer 9

lacy white lines, usually buccal
pain/burning wax/wane
likely immune-mediated
Tx: steroid, immunosuppressants
Lifetime malignant transf: 5-10%

Question 10

% of HPV SCC OC vs OP

Answer 10

OC: <3%
OP: >80%

Question 11

Should you include level IV in for oral tongue CA?

Answer 11

Usually OC drains to I-III
As many as 15% have involvement of III, IV without I, II
Consider it based on thickness/depth of invasion
Some use cutoff of 4mm invasion to treat neck electively at all (20% incidence microscopic mets)

Question 12

OC T4a vs 4b

Answer 12

4a: (lip) cortical bone, IAN, FOM, skin of face
(OC) through cortical bone into tongue extrinsic mm, maxillary sinus, skin of face (if only superficial erosion, not T4)
4b: masticator space, pterygoid plate, SB, ICA

Question 13

Nodal staging OC/OP (same as most H/N CA)

Answer 13

1: single ipsilat 3cm
2a: 3-6cm
2b: multiple LN
2c: contralateral
3: >6cm

Question 14

Workup for patients with OC/OP CA

Answer 14

CT neck w/ contrast
CT chest or PET/CT
LFTs

Question 15

OC CA margins

Answer 15

1-1.5cm intraop
tissue shrinks
need at least 5mm pathologically negative

Question 16

When to use postop adjuvant therapy for OC SCC

Answer 16

T3-4
High grade histo
perineural or lymphovascular invasion
infiltrate rather than pushing borders
close margins (<5mm) or positive (positive gets chemo + rads)
surgeon concerned about resection adequacy
N2+
Excisional or incisional nodal bx prior to definitive surg (got contaminated)
Extracapsular extension (gets chemo+rads)

Question 17

Sites of OP known to have bilateral LN drainage

Answer 17

SP, BOT, posterior ph wall

Question 18

Symptoms of OC CA, OP CA

Answer 18

pain, bleed, ulcer, change in speech, ear pain
OP CA commonly presents as isolated neck mass
OP CA: throat pain/full, dysphagia, odynophagia, ear pain, muffled voice, foul breath/taste, hemoptysis
Advanced OP Sx: trismus, DEC tongue mobility, airway obstruction

Question 19

Referred ear pain

Answer 19

tongue and FOM supplied by branch of V3 (also goes to EAC, TM, TMJ via auriculotemporal n)
Also IX, X

Question 20

How to differentiate fluid in metastatic SCC vs branchial cleft cyst

Answer 20

Difficult, both can have squamous debris…be wary of branchial cleft dx in older patient!

Question 21

Most common sites of HPV SCC

Answer 21

BOT, tonsil

Question 22

Prognosis of HPV SCC (in general)

Answer 22

better than HPV-negative

Question 23

4 HPV subtypes that are high risk

Answer 23

16, 18, 31, 33

Only 16 commonly seen in OP CA

Question 24

How cervical nodal metastasis affects prognosis of OC/OP CA

Answer 24

decreases survival up to 50%