Workup/Staging Flashcards
What nerves are responsible for otalgia in cancers of the oral tongue, BOT, and larynx/hypopharynx (HPX)?
Oral tongue: CN V (auriculotemporal) → preauricular area
BOT: CN IX (Jacobson nerve) → tympanic cavity
Larynx/HPX: CN X (Arnold nerve) → postauricular area
What are the 4 extrinsic tongue muscles, and what are their anatomic spans?
Extrinsic tongue muscles (-glossus) and anatomic spans:
Genioglossus (ant mandible to tongue)
Styloglossus (styloid process to tongue)
Palatoglossus (palate to tongue; also forms ant tonsillar pillar)
Hyoglossus (hyoid bone to tongue)
What is the most common presentation of OPC?
The most common presentation is a neck mass, especially with HPV+ OPC.
What are additional common presenting Sx by OPX subsite?
Base of tongue: sore throat, dysphagia, otalgia, neck mass
Tonsils: sore throat, trismus (T4b), otalgia, neck mass
Soft palate: leukoplakia, sore throat with swallowing, trismus/perforation, phonation defect with advanced lesions
Pharyngeal wall: pain/odynophagia, bleeding
Describe the workup for a pt with an OPX mass (per NCCN 2018).
OPX mass workup: H&P (bimanual exam of the floor of mouth), labs, laryngoscopy, CT/MRI with contrast H&N, tissue Bx with HPV testing (EUA if necessary), CT chest, consider PET/CT for stages III–IV Dz, nutrition, speech/swallow, audiogram
If the neck mass Bx is positive, is an additional Bx of the primary lesion necessary?
Yes. A Bx of the primary (or suspected primary) should also be done.
What % of OPC pts have clinically +nodes? Clinically occult nodes? Bilat nodes?
∼75% of OPC pts have clinically+ nodes at presentation, 30%–50% have clinically occult nodes, and ∼30% have bilat nodes (especially BOT/midline).
What is the T staging of p16(-) OPC? How is it different for p16(+) OPC?
T staging of p16(–) OPC is as follows:
T1: ≤2 cm
T2: >2 cm, ≤4 cm
T3: >4 cm or extension to lingual surface of epiglottis
T4a (moderately advanced): invades larynx, deep/extrinsic tongue muscles, medial pterygoid, hard palate, mandible
T4b (very advanced): invades lat pterygoid muscle, pterygoid plate, lat NPX, skull base, carotid encasement
For p16+ OPC, T4a and T4b are combined into a single T4 designation.
What are the N and summary staging of p16(-) OPC?
N and summary staging for p16(–) OPC are the same as other H&N sites (except for NPX).
N1: single ipsi, ≤3 cm, ENE(–)
N2a: single ipsi, >3 cm, ≤6 cm, ENE(–)
N2b: multiple ipsi, ≤6 cm, ENE(–)
N2c: any bilat or contralat, ≤6 cm, ENE(–)
N3a: any >6 cm, ENE(–)
N3b: any clinically overt ENE(+)
Stage I: T1N0
Stage II: T2N0
Stage III: T3N0 or T1–3N1
Stage IVA: T4aN0–1 or T1–4aN2
Stage IVB: T4b any N or any T N3
Stage IVC: any T any N M1
What is the N staging of p16(+) OPC?
Clinical
N1: any ipsi, ≤6 cm
N2: any contra or bilat LNs, ≤6 cm
N3: any >6 cm
Pathologic
N1: ≤4 LN positive
N2: >4 LN positive
What is the overall stage grouping for p16(+) OPC?
Clinical
Stage I: T1–2 N0–1
Stage II: T1–2 N2 or T3 N0–2
Stage III: any T N3 or T4 any N
Stage IV: M1
Pathologic
Stage I: T1–2 N0–1
Stage II: T1–2 N2 or T3–T4 N0–1
Stage III: T3–4 N2
Stage IV: M1
