Tongue cancer staging
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Tongue cancer Microchapters |
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Tongue cancer staging On the Web |
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American Roentgen Ray Society Images of Tongue cancer staging |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2] Mohammed Abdelwahed M.D[3] Roukoz A. Karam, M.D.[4]
Overview
According to the TNM staging system by the American Joint Committee on Cancer, there are four stages of oral cancer based on the tumor size, lymph nodes involved, and metastasis.[1][2]
Staging
A common staging system is used for all squamous cell carcinomas of the oral cavity, with tumor staging being based on size and extension into adjacent structures. Nodal staging is the same as that used for squamous cell carcinomas of the oral cavity, oropharynx, hypopharynx and larynx.[1] The following features are assessed on either CT or MRI:[3]
- Size of tumor and tumor thickness
- Extension across the midline
- Extension beyond the intrinsic muscles of the tongue
- Involvement of adjacent structures
- Neurovascular bundle and submandibular duct in the floor of mouth
- Mandible
T Categories for tongue cancer
| T Classification | Thickness |
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Primary tumor cannot be assessed |
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No evidence of a primary tumor |
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Carcinoma in situ |
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Tumor ≤2 cm in greatest dimension |
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Tumor >2 cm but ≤4 cm in greatest dimension |
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Tumor >4 cm in greatest dimension |
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Moderately advanced local disease
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Very advanced local disease.
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b Mucosal extension to lingual surface of epiglottis from primary tumors of the base of the tongue and vallecula does not constitute invasion of larynx.
N Categories for tongue cancer b
Lymphatic drainage of the tongue is extensive, accounting presumably for the high rate of nodal metastases present at the time of diagnosis. Drainage patterns depend on the location of the primary lesion:
- Anterior tongue: level Ia nodes (submental nodes)
- Lateral tongue
- Level Ib nodes: submandibular
- Level II nodes: upper jugulodigastic nodes
- Potentially drain directly to level IV nodes
- Posterior tongue: level II nodes (upper jugulodigastic nodes)
It is important to remember that significant lymphatic drainage occurs across the midline, and thus the nodes of both sides of the neck need to be carefully examined for presence of nodal metastases. The incidence of lymph node metastases correlates with tumor thickness, which is best assessed on coronal images
| N Classification | Nodal Mass |
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Regional lymph nodes cannot be assessed |
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No regional lymph node metastasis |
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Metastasis in a single ipsilateral lymph node, ≤3 cm in greatest dimension |
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Metastasis in single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension |
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Metastases in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension |
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Metastases in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension |
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Metastasis in a lymph node >6 cm in greatest dimension |
b Metastases at level VII are considered regional lymph node metastases
M Categories for tongue cancer
| M Classification | Definition |
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No distant metastasis |
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Distant metastasis |
Stages of tongue cancer
| Stage | T | N | M |
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References
- ↑ 1.0 1.1 Ahuja, Anil (2003). Imaging in head and neck cancer : a practical approach. London San Francisco: Greenwich Medical Media. ISBN 1841100900.
- ↑ Edge, Stephen (2010). AJCC cancer staging manual. New York: Springer. ISBN 0387884408.
- ↑ Sigal R, Zagdanski AM, Schwaab G, Bosq J, Auperin A, Laplanche A; et al. (1996). "CT and MR imaging of squamous cell carcinoma of the tongue and floor of the mouth". Radiographics. 16 (4): 787–810. doi:10.1148/radiographics.16.4.8835972. PMID 8835972.