Oral Cancer Staging

[DrTacoElf]

Is oral cancer staging in terms of lymph nodes based on clinical or radiographic findings?

For instance if you have a T2 scc (greater than 2cm but less than 4cm) on the lateral border of the tongue without any palpable lymph nodes and you get a CT Neck which does show an enlarged lymph node in level II does this automatically make the patient T2N1 and therefore a stage III instead of T2N0 stage II.

Thanks for the help

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[OtoHNS]

Is oral cancer staging in terms of lymph nodes based on clinical or radiographic findings?

For instance if you have a T2 scc (greater than 2cm but less than 4cm) on the lateral border of the tongue without any palpable lymph nodes and you get a CT Neck which does show an enlarged lymph node in level II does this automatically make the patient T2N1 and therefore a stage III instead of T2N0 stage II.

Thanks for the help

You need to factor both the physical exam as well as the radiologic images into the clinical staging of a cancer. Metastatic lymph nodes are generally not subtle, so if there is a truly enlarged node (i.e. >1 cm), you should be able to feel it.

You can also look at the imaging- benign reactive nodes are usually smooth and oblong. Malignant nodes usually show central necrosis.

It's ok to be uncertain- you can never know for certain unless you have a specimen for the pathologist.

Your hypothetical patient should get a neck dissection whether or not the node is positive, so you'll find out the pathologic staging either way.