Diagnosis and Staging

By Dr. Vishaal Bhat on Monday, 19 November, 2007 with 0 comments

The majority of head and neck tumors affects men older than 50 years. Although, the lower age boundary has shifted to earlier decades which supports again theories on participation of genetic and immunologic basis in the process of carcinogenesis. Patients with early stages of a carcinoma at the oral cavity sense vague, non-characteristic symptoms of discomfort inside the mouth; and a physical findings are usually not very convincing, either. It is this phase of a malignant disease development that has to be immediately predicted and carefully dealt with by dentists, general physicians and oral surgeons. General signs of the oral cavity carcinoma are a local pain, non-healing mucous ulcerations and changes in position and adhesion of dentures. Oropharyngeal tumors manifest themselves later and that is why they get diagnosed only at progressive stages. Later phases of tumors of the above discussed locations exhibit more distinct symptomatology. It includes an increasing pain, contracture of jaws, difficulties to swallow, restricted movability of the tongue and its base, formation of inner and outer fistulas and cervical node reaction. Failures of a neurologic sensitivity and motility of facial areas are also significant (branches of n. trigemini, n. facialis).

Oncologically oriented examination of the mouth and upper parts of neck should be a routine part of every periodical check at a dentist’s or a general physician’s office. Besides a careful aspection of visible parts of mucosa it is necessary to palpate bimanually the oral base, the whole tongue and the neck lymphatic nodes. Suspicious areas and the above mentioned precancerous states have to be clarified by biopsies. A diagnostic excision is the most exact diagnostic method of a malignant process and the most weighty foundation for determination of a course of therapy.

A clinical check should be complemented with sonography and modern methods of X-ray examinations. Computer tomography (CT) and magnetic resonance (MR) specify an extent and nature of a tumor and determine its relationship to surrounding organs (bones, blood vessels, nerves), as well as these methods point out at an infiltration of regional nodes. The classification system TNM (tumor, nodi lymphatici, metastases) integrates all clinical information according to the international rules (UICC) for purposes of staging (determination of a stage) of a malignant disease.

The following classification scheme is valid for carcinomas of the lips and oral cavity:

T1 = 2 cm

T2 2 - 4 cm

T3 4 cm

T4 infiltration of adjacent structures (the bone)

N1 ipsilateral solitary = 3 cm

N2 ipsilateral solitary 3 - 6 cm

ipsilateral solitary 6 cm

bilateral, contralateral = 6 cm

N3 6 cm

M0 remote nodes negative

M1 remote nodes positive

The 1st to the 4th stages of a malignant disease (staging) are determined by combination of the above elements of classification. Staging is a respected groundwork for choosing an optimum therapy and a guideline for a disease prognosis.

Category: Stomatology Notes



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