Interactive Transcript
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Hello everyone, it's Dr. Sidney Levy here.
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3 00:00:04,670 --> 00:00:06,450 Today I'll be talking about the
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staging of oropharyngeal malignancy.
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And I would like to begin with T staging.
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The first thing to say is that T staging
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is very similar to that of the oral cavity,
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which we have discussed in other vignettes.
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And it is almost exactly the same
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as the hypopharynx and the larynx.
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With the exception of specific structures that
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tend to be involved in more advanced disease.
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The difference between oropharyngeal and oral cavity
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malignancy staging is that depth of invasion is
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not taken into account in oropharyngeal malignancy.
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Depth of invasion is a concept that has been
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introduced in the most recent AJCC 8th edition
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staging guidelines for oral cavity malignancy only.
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So, in general terms, we have T1, T2, T3, and T4.
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T4 is split into T4a and T4b.
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I have an example case, which I will stage for you, but
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firstly, I'd like to go through the general definitions.
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T1 disease is tumor which is less
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than or equal to 2 centimeters.
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T2 tumor is tumor which is greater than 2
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centimeters but less than or equal to 4 centimeters.
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T3 tumor is tumor which measures
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greater than 4 centimeters, or extends
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to the lingual surface of the epiglottis.
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T4a tumor invades the larynx, the medial pterygoid,
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extrinsic tongue musculature, hard palate, or
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mandible. And T4b tumor invades the lateral
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pterygoid, pterygoid plates, lateral nasopharynx,
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skull base, or encases the carotid artery.
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So, firstly, what do I mean by tumor dimensions?
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It must be the maximal dimension of the tumor.
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So that might be in the superoinferior,
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anteroposterior, or transverse dimension.
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What is the lingual surface of the epiglottis?
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Let me demonstrate that for you.
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So our base of tongue malignancy that we're going
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to use as our case example is outlined here.
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The lingual surface of the epiglottis is here.
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The laryngeal surface of the
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epiglottis is the other side.
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Other definitions, what are
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the extrinsic tongue muscles?
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There are several groups, but the one that tends to be
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involved first and most commonly is the genioglossus.
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And if you're ever in any doubt, the T1
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pre-contrast, non-fat suppressed imaging
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is the easiest way to look for these.
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So, let me draw them for you.
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Other muscle groups which may be involved are the
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mylohyoid, the hyoglossus, or the geniohyoid.
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We have a separate vignette which covers
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the anatomy of this region, which I
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would refer you to as an extra reference.
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In our next vignette, we will discuss the
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end staging of oropharyngeal malignancy
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and draw attention to the differences that
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occur between tumors that are classified as
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human papillomavirus positive or negative.
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