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Stage Information for Lip and Oral Cavity Cancer

    The staging systems are all clinical staging and are based on the best possible estimate of the extent of disease before treatment. The assessment of the primary tumor is based on inspection and palpation when possible and by both indirect mirror examination and direct endoscopy when necessary. The tumor must be confirmed histologically, and any other pathologic data obtained on biopsy may be included. The appropriate nodal drainage areas are examined by careful palpation. Information from diagnostic imaging studies may be used in staging. Magnetic resonance imaging offers an advantage over computed tomographic scans in the detection and localization of head and neck tumors and in the distinction of lymph nodes from blood vessels.[1] If a patient relapses, complete restaging must be done to select the appropriate additional therapy.[2,3]

    Definitions of TNM

    The American Joint Committee on Cancer has designated staging by TNM classification to define lip and oral cavity cancer.[4]

    Table 1. Primary Tumor (T)a

    a Reprinted with permission from AJCC: Lip and oral cavity. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 29-40.
    b Superficial erosion alone of bone/tooth socket by gingival primary is not sufficient to classify a tumor as T4.
    TXPrimary tumor cannot be assessed.
    T0No evidence of primary tumor.
    TisCarcinomain situ.
    T1Tumor ≤2 cm in greatest dimension.
    T2Tumor >2 cm but ≤4 cm in greatest dimension.
    T3Tumor >4 cm in greatest dimension.
    T4aModerately advanced local disease.b
    (Lip) Tumor invades through cortical bone, inferior alveolar nerve, floor of mouth, or skin of face, that is, chin or nose.
    (Oral cavity) Tumor invades adjacent structures only (e.g., through cortical bone [mandible or maxilla] into deep [extrinsic] muscle of tongue [genioglossus, hyoglossus, palatoglossus, and styloglossus], maxillary sinus, or skin of face).
    T4bVery advanced local disease.
    Tumor invades masticator space, pterygoid plates, or skull base and/or encases internal carotid artery.

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