Chapter 12 - Oral Cavity, Oropharynx Flashcards
Where OC and OP CAs spread
OC: LN I-III (supraomohyoid)
OP: LN II-IV, retroph, paraph
General T staging criteria OC/OP
1: 0-2cm
2: 2-4cm
3: >4cm
4: extension to adjacent structures
Basic, main difference between Tx of OC/OP CA
OC: Surgery
OP: Rads
% of OC CAs that are SCC
90
CAs in OC other than SCC
Minor salivary (hard palate, adenoid cystic)
Kaposi or other sarcoma
melanoma
lymphoma
Most common SCC sites OC
- Lips (15-30%), low (>90%)
2. Oral tongue (20-30%), lateral > dorsal
Leukoplakia
white plaque/patch
cannot be rubbed off
chronic trauma/irritation
always bx, tough to predict transformation, then f/u or excise based on path
Erythroplakia
red plaque, not from obvious mechanical/inflammatory cause
7x more malignant potential than leuko
complete excision, margins
Oral lichen planus
lacy white lines, usually buccal pain/burning wax/wane likely immune-mediated Tx: steroid, immunosuppressants Lifetime malignant transf: 5-10%
% of HPV SCC OC vs OP
OC: <3%
OP: >80%
Should you include level IV in for oral tongue CA?
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)
OC T4a vs 4b
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
Nodal staging OC/OP (same as most H/N CA)
1: single ipsilat 3cm
2a: 3-6cm
2b: multiple LN
2c: contralateral
3: >6cm
Workup for patients with OC/OP CA
CT neck w/ contrast
CT chest or PET/CT
LFTs
OC CA margins
1-1.5cm intraop
tissue shrinks
need at least 5mm pathologically negative
When to use postop adjuvant therapy for OC SCC
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)
Sites of OP known to have bilateral LN drainage
SP, BOT, posterior ph wall
Symptoms of OC CA, OP CA
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
Referred ear pain
tongue and FOM supplied by branch of V3 (also goes to EAC, TM, TMJ via auriculotemporal n)
Also IX, X
How to differentiate fluid in metastatic SCC vs branchial cleft cyst
Difficult, both can have squamous debris…be wary of branchial cleft dx in older patient!
Most common sites of HPV SCC
BOT, tonsil
Prognosis of HPV SCC (in general)
better than HPV-negative
4 HPV subtypes that are high risk
16, 18, 31, 33
Only 16 commonly seen in OP CA
How cervical nodal metastasis affects prognosis of OC/OP CA
decreases survival up to 50%
