40 Questions
Which of the following is classified as N2-Metastasis?
All of the above
What is the characteristic of N3-Metastasis?
Metastasis in a lymph node >6 cm in greatest dimension and ENE (-)
What is the classification of a tumor with no distant metastasis?
M0
What is the characteristic of M1-Metastasis?
Distant metastasis
What is N2a-Metastasis?
Metastasis in a single ipsilateral lymph node >3 cm
What is the classification of a tumor with metastasis in multiple ipsilateral lymph nodes?
N2b
What is the characteristic of N2c-Metastasis?
Metastasis in bilateral or contralateral lymph nodes
What is the classification of a tumor with metastasis in any lymph node(s) with clinically overt ENE (+)?
N3f
What is the result of exposure to carcinogens?
Malignant transformation of cells
Which of the following increases the risk for the development of oral cancer?
Pipe and cigar smoking
What is the purpose of dividing the neck into seven anatomic and radiographic levels?
To facilitate communication between clinicians
What is the boundary of the submental triangle?
Anterior belly of the digastric muscles laterally, the hyoid bone inferiorly, and the mandibular symphysis superiorly
What is the main risk associated with smokeless tobaccos in the United States?
Increased risk of gingival and buccal cancers
In which region is the use of tobacco and betel nut a significant risk factor for oral cancer?
Parts of India and Southeast Asia
What is the benefit of using MRI over CT for evaluating the neck for metastatic disease?
MRI is more accurate than CT for detecting metastatic disease
What is the purpose of the heating element in an e-cigarette?
To vaporize the nicotine
How many lymph nodes are in the neck?
Over 300 lymph nodes
What is the purpose of removing the submandibular gland during surgical management of the neck?
To facilitate complete clearance of all lymph nodes at level IIB
What has been identified in the saliva of e-cigarette users?
N-nitrosonornicotine
What is the result of e-cigarette use on DNA in vitro?
Induction of DNA strand breaks
What type of lymph nodes may harbor metastases for primary sites such as the lip, buccal mucosa, anterior nasal cavity, or soft tissue of the cheek?
Perifacial lymph nodes, including buccinator nodes
What is the association between marijuana use and development of oral squamous cell carcinoma?
No increased risk
What is the clinical evaluation of the neck based on?
Clinical examination and imaging
What is the term for the nodes that lie within the boundaries of the submandibular triangle?
Submandibular nodes
What is the term used to describe the phenomenon where precancerous conditions make every part of the oral cavity susceptible to cancer conversion?
Field cancerization
What is the most common precancerous condition seen in India?
Oral submucous fibrosis (OSMF)
What is the term used to describe the development of a second primary despite adequate treatment of the first?
Second primary
What is the name of the committee that divides the oral cavity into seven distinct subsites?
American Joint Committee on Cancer (AJCC)
What is the most common subsite affected by OSCC?
Floor of mouth and tongue
What is the term used to describe the pathology of the oral mucosa that has a tendency to transform into squamous cell carcinoma?
Precancerous lesion
What is the term used to describe the boundary of the oral cavity posteriorly and superiorly?
Junction of the hard and soft palate
What is the name of the precancerous lesion that is characterized by a white patch on the oral mucosa?
Leukoplakia
What is the common presentation of oral squamous cell carcinoma?
An indurated ulcer, exophytic growth, or indurated non-ulcerative patch
What is the importance of palpation in the diagnosis of oral squamous cell carcinoma?
To assess the potential depth of invasion
What is a common indicator of muscle involvement in oral squamous cell carcinoma?
Trismus
What is the significance of otalgia in the diagnosis of oral squamous cell carcinoma?
Indicates involvement of the ninth and tenth cranial nerves
What is the importance of evaluating the neck in oral squamous cell carcinoma?
To assess the potential for lymph node involvement
What is the role of imaging in the diagnosis of oral squamous cell carcinoma?
To visualize the complete extension of the primary tumor and of any nodal disease
What is a common indicator of neurologic involvement in oral squamous cell carcinoma?
Paresthesias
What is the importance of evaluation of distant metastasis in oral squamous cell carcinoma?
To form a part of the staging process
Study Notes
Neck Evaluation
- MRI is recommended as the standard of care for evaluating the neck for metastatic disease compared to CT.
- The neck is divided into seven anatomic and radiographic levels (I-VII) to assist with treatment planning.
- Each level should be evaluated systematically with clinical examination and imaging.
Lymph Node Levels
- Level I is divided into two lymph node groups: IA (submental group) and IB (submandibular nodes).
- Level IA includes nodes within the submental triangle, bordered by the anterior belly of the digastric muscles, hyoid bone, and mandibular symphysis.
- Level IB includes nodes within the submandibular triangle, bordered by the anterior and posterior bellies of the digastric muscles, mandible, and stylohyoid muscle.
Risk Factors for Oral Cancer
- Smoking and tobacco use are significant risk factors for oral cancer.
- Smokeless tobaccos and chewed tobacco have been shown to increase the risk of oral cancer.
- Electronic cigarettes have been found to contain carcinogens and may increase the risk of oral cancer.
- Marijuana use has not been shown to be associated with an increased risk of oral squamous cell carcinoma (OSCC).
Precancerous Situations
- Precancerous situations can be divided into precancerous conditions and precancerous lesions.
- Examples of precancerous conditions include oral submucous fibrosis (OSMF) and oral lichen planus.
- Precancerous lesions include leukoplakia, erythroplakia, carcinoma in situ, and smoker's palate.
Subsites of the Oral Cavity
- The oral cavity is divided into seven subsites: mucosal lip, buccal mucosa, floor of the mouth, oral tongue, mandibular gingiva and alveolar ridge, maxillary gingiva, alveolar ridge, and hard palate, and retromolar trigone.
- Defining the origin subsite of OSCC has important implications on surgical management, adjuvant therapy, and survival.
Diagnosis of Oral Squamous Cell Carcinoma (OSCC)
- Clinical features of OSCC may include an indurated ulcer, exophytic growth, or a non-ulcerative patch.
- Important parameters to be recorded during clinical examination include site of the tumor, size, extension to adjacent structures, and evidence of tumor spread to adjacent structures.
- Imaging techniques can be used to visualize the primary tumor and nodal disease.
Staging of OSCC
- The TNM staging system is used to classify OSCC based on tumor size, nodal involvement, and metastasis.
- N2 metastasis includes a single ipsilateral lymph node > 3 cm but ≤ 6 cm in greatest dimension and ENE (-).
- N3 metastasis includes a lymph node > 6 cm in greatest dimension and ENE (-) or any lymph node(s) with clinically overt ENE (+).
This quiz covers the evaluation and treatment of metastatic disease in the neck, specifically for oral squamous cell carcinoma (OSCC) tumors. It includes the use of MRI and CT scans, and the classification of lymph nodes into seven anatomic levels.
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