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Staging Oropharynx Cancer, T-staging

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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.

Report

Description

Faculty

Sidney Levy, PhD, MBBS

Radiologist and Nuclear Medicine Specialist

I-MED

Tags

Oral Cavity/Oropharynx

Neuroradiology

Neuro

Neoplastic

MRI

Head and Neck

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