AJCC Cancer Staging Manual by (auth.), Frederick L. Greene M.D., David L. Page M.D., Irvin

By (auth.), Frederick L. Greene M.D., David L. Page M.D., Irvin D. Fleming M.D., April G. Fritz C.T.R., R.H.I.T., Charles M. Balch M.D., Daniel G. Haller M.D., Monica Morrow M.D. (eds.)

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Ultrasonography may be helpful in assessment of major vascular invasion as an adjunctive test. The tumor must be confirmed histologically. All clinical, imaging, and pathologic data available prior to first definitive treatment may be used for clinical staging. ~linical IS Regional Lymph Nodes. Mucosal cancer of the oral cavity may spread to regionallyrnph node(s). Tumors of each anatomic site have their own predictable patterns of regional spread. The risk of regional metastasis is generally related to the T category and, probably more important, to the depth of infiltration of the primary tumor.

C~ncer of the anterior oral tongue may spread directly to lower Jugular nodes. The doser to the midline the primary, the ~reater the risk of bilateral cervical nodal spread. Any prevlOUS treatment to the neck, surgical and/or radiation, may alter normal lymphatic drainage patterns, resulting in unusual distribution of regional spread of disease to the cervicallymph nodes. In general, cervicallymph node involvement from oral cavity primary sites is predictable and orderly, spreading from the primary to upper, then middle, and subsequently lower cervical nodes.

Head and Neck 22:799-807, 2000 Deleyiannis FW, Thomas DB, Vaughan TL, et al: Alcoholism: independent predictor of survival in patients with head and neck cancer. J Natl Cancer Inst 88:542-549,1996 Evans JF, Shah JP: Epidermoid carcinoma of the palate. Am J Surg 142:451-455, 1981 Faye-Lund H, Abdelnoor M: Prognostic factors of survival in a cohort ofhead and neck cancer patients in Oslo. Eur J Cancer B Oral OncoI2:83-90, 1996 Franceschi D, Gupta R, Spiro RH, et al: Improved survival in the treatment of squamous carcinoma of the oral tongue.

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