Symposium on malignancy. II. Occult regional metastasis: Carcinoma of the oral tongue

Abstract

Review of charts of 158 patients with carcinoma of the oral tongue revealed 108 (68 percent) were clinically free of cervical metastasis upon presentation. Patients who were found to have microscopic metastases after elective neck dissection and patients who developed cervical metastases but never a local recurrence were said to have occult regional metastases. The incidence of occult metastases was 23 percent with no difference between T1, T2, and T3 lesions. Determinant survival rates of the T1N0M0 groups were 83 percent and 57 percent at two and five years respectively. Survival rates of the T1N0M0 patients who had occult metastases were comparable (82 percent and 50 percent respectively). Survival rates of patients with T2N0M0 and T3N0M0 lesions with occult metastases were lower than for all patients in each of the two groups. The incidence of local recurrence in these same 108 patients was 27 percent with the incidence highest in the T2N0M0 group (31 percent). Survival rates of these patients, especially of those who developed regional metastases, were lower in all three groups of patients. The combined use of pre‐operative irradiation with cobalt 60 followed by en bloc resection of the primary tumor with the regional lymphatics has been very effective to date. The following conclusions are based on retrospective study of carcinoma of the oral tongue. The incidence of occult regional metastasis is the same for T1 and T2 primary cancers of the oral tongue. To date, combined therapy is resulting in higher survival rates in patients with larger oral tongue carcinomas. To increase the probability of cure, elective treatment of regional lymphatics either by radical neck dissection or irradiation should be considered in the treatment of T1N0M0 epidermoid carcinoma of the oral tongue.

Evaluating lingual carcinoma for surgical management: what does volumetric measurement with MRI offer?

“…The prognostic value of TNM staging of oral malignancy has been called into question by numerous authors [4][5][6][7]. In our study, the cT predicted pT in only 46.2% of cases.…”

“…Criticism of the current TNM (tumour, node, metastasis) staging criteria has resulted from several studies showing that the size-based T criteria fail to demonstrate a significant relationship with patient survival [4,5]. Lenz et al [6] found that clinical T stage (cT) of oral cancer predicted the pathology T stage (pT) only 47% of the time.…”

DNA content, malignancy grading and prognosis in T1 and T2 oral cavity carcinomas

“…The presence of cervical lymph node metastases seems to be the most important predictor associated with approximately 50 per cent reduction of the 2-year determinate survival rate (Hibbert et al, 1983; Teichgraeber et al, 1973;Willen et al, 1975; Lund et al, 1975) have cavity carcinoma provides useful prognostic information but has certain limitations. The single method treatment of stage I cancer carries a much poorer prognosis than was previously thought, and the incidence of microscopic cervical metastases is high (Lee et al, 1972;Krause et al, 1973;Teichgraeber et al, 1984).The malignancy grading system based on 4 different morphological characteristics for the tumour cell population, and 4 characteristics for the tumour-host relationship, initially used in the analysis of laryngeal cancer (Jakobsson et al, 1973), has also been applied in oral cavity carcinomas.Studies on palatal, gingival, and lingual carcinomas Willen et al, 1975; Lund et al, 1975) have disclosed statistically significant differences in survival for patients with high and low malignancy scores. The somewhat modified malignancy grading used in lingual carcinomas by Holm et al (1982) showed a correlation between the malignancy score on the one hand and T classification or the presence of lymph node metastases at the time of diagnosis on the other.…”

“…Factors influencing the prognosis are therefore sought after. The site and size of the primary tumour and the presence of metastases have been used as prognostic indicators (Lee et al, 1972; Krause et al, 1973;Fletcher, 1979). The presence of cervical lymph node metastases seems to be the most important predictor associated with approximately 50 per cent reduction of the 2-year determinate survival rate (Hibbert et al, 1983;Teichgraeber et al, 1973;Willen et al, 1975;Lund et al, 1975) have cavity carcinoma provides useful prognostic information but has certain limitations.…”

Neck treatment of patients with early stage oral tongue cancer

“…Patients with oral cavity cancer have a high incidence of occult cervical metastases, 13,15,[20][21][22][23] poor salvage rates, 15,[20][21][22]24 and an increased incidence of ECS in the presence of palpable lymph nodes. 17 Notably, the presence of occult lymph node metastases represents a significant adverse prognostic factor in this patient group.…”