Oral Cancer

Question 1

T/F: Oral cancer is the m/c site of H&N CA and has the highest rate of second primaries

Answer 1

True
30% of all H&N CA
10-40% rate of second primaries

Question 2

Where does occult metatstatic dz typically affect?

Answer 2

> 90% is Level I-III nodes

Question 3

What is the anatomic boundaries of the oral cavity

Answer 3

Lips to the junction of the hard and soft palate and the circumvallate papillae

Question 4

What is the m/c site of oral cancer?

Answer 4

Lips

Oral tongue is 2nd m/c

Question 5

Lip cancer rule of 90’s

Answer 5

90% lower lip
90% 5-yr survival if < 2 cm
90% is SCCa (BCCa is m/c on upper lip)

Question 6

What nodal levels to the lips drain to

Answer 6

Upper lip: IPSI I-III

Lower lip: Bilateral I-III

Question 7

Lip cancer poor prognostic indicators

Answer 7

• Upper lip

- Commissure involvement

Question 8

Where does CA due to Betel nuts usu occur?

Answer 8

Buccal mucosa

Question 9

Retromolar trigone

Answer 9

Triangle shaped region w/ base at the last mandibular molar and apex at the maxillary tuberosity
CA here typically presents late and commonly w/ bony invasion

Question 10

Hard palate CA

Answer 10

Incisive foramen allows tumor extension into anterior nose
Palatine foramen allows extension into PPF
less aggressive
Minor salivary gland tumors common

Question 11

T4a Oral cancer tumor stage

Answer 11

Moderately advanced local dz

• Invasion through cortical bone
• Inferior alveolar nerve
• FOM
• Skin
• Extrinsic muscle of tongue
• Maxillary sinus

Question 12

T4b Oral cancer tumor stage

Answer 12

Very advanced local dz

• Invasion through masticator space
• Ptyergoid plates
• Skull base
• Encasing ICA

Question 13

Verrucous carcinoma

Answer 13

• A variant of SCCa
• Broad based
• Warty growth
• M/c site is buccal mucosa
• Lateral growth
• Rare mets and deep invasion
• Better prognosis

Question 14

What pathology is commonly mistaken for SCCa of the oral cavity

Answer 14

Necrotizing sialometaplasia and granular cell tumors bc of similar histology (pseudoepitheliomatous hyperplasia)

Question 15

MAN of early oral CA (T1-T2)

Answer 15

-Single modality Rx: Excision vs XRT
-N0 neck: elective IPSI or b/l (midline or oral tongue CA) SND (I-III) vs XRT
Note: Early-stage hard palate or lower lip don’t require elective ND bc of low rate of occult met
-N1-N3 neck: modified RND + superficial parotidectomy if parotid nodes

Question 16

MAN of advanced oral CA (T3-T4)

Answer 16

• Single modality Rx: Excision vs XRT
• N0 neck: elective IPSI or b/l (midline or oral tongue CA) SND (I-III) vs XRT
• N1-N3 neck: modified RND + superficial parotidectomy if parotid nodes
• Adjuvant Rx: Postop RT for
• -Positive margins
• -Multiple positive neck nodes
• -ECS
• -PNI
• -Intravascular invasion
• -Invasion of bone, cartilage, or soft tissue
• Chemo for palliation or for adjuvant Rx

Question 17

MAN of lip CA

Answer 17

• Single modality Rx: Excision (consider Mohs) vs XRT
• Adjuvant Rx: postop RT for:
• -Advanced (T3-T4, N2-N3)
• -Close/positive margins
• -Multiple neck nodes
• -ECS/PNI/Intravascular invasion
• N0 neck: elective IPSI or b/l (for lower lip) SND I-III vs XRT for T3-T4
• N1-N3 neck: modified RND for nodes + sup parotid if parotid nodes
• Chemo for palliation or adjuvant for advanced

Question 18

Surgical approaches for oral cancer

Answer 18

• Intra-oral (anterior and small tumors < 2 cm)
• Transmandibular
• Transcervical

Question 19

How to treat invasion and abutment of the mandible

Answer 19

Invasion: segmental mandibulectomy
Abutment: marginal or rim mandibulectomy