Upper Aerodigestive Tract (Including Salivary Glands) Protocol applies to all invasive carcinomas of the upper aerodigestive tract including the oral cavity (including lip and tongue), pharynx


D. Classification of Neck Dissection



Download 266 Kb.
Page6/9
Date31.01.2017
Size266 Kb.
1   2   3   4   5   6   7   8   9

D. Classification of Neck Dissection


1. Radical neck dissection

2. Modified radical neck dissection, internal jugular vein and/or sternocleidomastoid muscle spared

3. Selective neck dissection, as specified by the surgeon

a. Supraomohyoid neck dissection

b. Posterolateral neck dissection

c. Lateral neck dissection

d. Central compartment neck dissection

e. Others

4. Extended radical neck dissection, as specified by the surgeon

E. TNM and Stage Groupings


The protocol recommends the TNM staging system of the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC) for head and neck cancer.1,2 Separate categories and stage grouping classifications for the various specific sites of the aerodigestive tract (including salivary glands) are enumerated individually below.
By AJCC/UICC convention, the designation “T” refers to a primary tumor that has not been previously treated. The symbol “p” refers to the pathologic classification of the TNM, as opposed to the clinical classification, and is based on gross and microscopic examination. pT entails a resection of the primary tumor or biopsy adequate to evaluate the highest pT category, pN entails removal of nodes adequate to validate lymph node metastasis, and pM implies microscopic examination of distant lesions. Clinical classification (cTNM) is usually carried out by the referring physician before treatment during initial evaluation of the patient or when pathologic classification is not possible.
Pathologic staging is usually performed after surgical resection of the primary tumor. Pathologic staging depends on pathologic documentation of the anatomic extent of disease, whether or not the primary tumor has been completely removed. If a biopsied tumor is not resected for any reason (eg, when technically unfeasible) and if the highest T and N categories or the M1 category of the tumor can be confirmed microscopically, the criteria for pathologic classification and staging have been satisfied without total removal of the primary cancer.

Lip and Oral Cavity




Anatomical Sites and Subsites for Lip and Oral Cavity

Lip


External upper lip (vermilion border)

External lower lip (vermilion border)

Commissures

Oral Cavity


Buccal mucosa

Mucosa of upper and lower lips

Cheek mucosa

Retromolar areas

Bucco-alveolar sulci, upper and lower (vestibule of mouth)

Upper alveolus and gingiva (upper gum)

Lower alveolus and gingiva (lower gum)

Hard palate

Tongue

Dorsal surface and lateral borders anterior to vallate papillae


(anterior two-thirds)

Inferior (ventral) surface

Floor of mouth

Primary Tumor (T): Lip and Oral Cavity


TX Primary tumor cannot be assessed

T0 No evidence of primary tumor

Tis Carcinoma in situ

T1 Tumor 2 cm or less in greatest dimension

T2 Tumor more than 2 cm but not more than 4 cm in greatest dimension

T3 Tumor more than 4 cm in greatest dimension

T4a Lip: Tumor invades through cortical bone, inferior alveolar nerve, floor of mouth, or skin (chin or nose)

T4a Oral cavity: Tumor invades through cortical bone, into deep/extrinisic muscle of tongue (genioglossus, hyoglossus, palatoglossus, and styloglossus), maxillary sinus or skin of face

T4b Lip and oral cavity: Tumor invades masticator space, pterygoid plate, or skull base, or encases internal carotid artery
Note: Superficial erosion alone of bone/tooth socket by primary gingival tumor is not sufficient to classify a tumor as T4.

Pharynx

Anatomical Sites and Subsites for Pharynx

Oropharynx


Anterior wall (glosso-epiglottic area)

Base of tongue (posterior to the vallate papillae or posterior third)

Vallecula

Lateral wall

Tonsil

Tonsillar fossa and tonsillar (faucial) pillars



Glossotonsillar sulci

Posterior wall

Superior wall

Inferior surface of soft palate

Uvula

Nasopharynx


Postero-superior wall: junction of the hard and soft palates to the base of the skull

Lateral wall: includes fossa of Rosenmuller

Inferior wall: superior surface of the soft palate
Note: The margin of the choanal orifices, including the posterior margin of the nasal septum, is included with the nasal fossa.

Hypopharynx


Pharyngo-esophageal junction (postcricoid area): level of arytenoid cartilages and connecting folds to inferior border of cricoid cartilage (forming anterior wall of hypopharynx)

Pyriform sinus: pharyngoepiglottic fold to the upper end of the esophagus, bounded laterally by the thyroid cartilage and medially by the hypopharyngeal surface of the aryepiglottic fold and the arytenoid and cricoid cartilages

Posterior pharyngeal wall: superior level of the hyoid bone (floor of the vallecula) to the inferior border of the cricoid cartilage and the apex of one pyriform sinus to the other

Primary Tumor (T): Oropharynx


TX Primary tumor cannot be assessed

T0 No evidence of primary tumor

Tis Carcinoma in situ

T1 Tumor 2 cm or less in greatest dimension

T2 Tumor more than 2 cm but not more than 4 cm in greatest dimension

T3 Tumor more than 4 cm in greatest dimension

T4a Tumor invades any of the following: larynx, deep/extrinsic muscle of tongue (genioglossus, hyoglossus, palatoglossus, and styloglossus), medial pterygoid muscle, hard palate, and mandible

T4b Tumor invades any of the following: lateral pterygoid muscle, pterygoid plates, lateral nasopharynx, skull base; or encases the carotid artery



Primary Tumor (T): Nasopharynx


T1 Tumor confined to nasopharynx

T2 Tumor extends to soft tissue of oropharynx and/or nasal fossa

T2a T2 without parapharyngeal extension#

T2b T2 with parapharyngeal extension#

T3 Tumor invades bony structures and/or paranasal sinuses

T4 Tumor with intracranial extension and/or involvement of cranial nerves, infratemporal fossa, hypopharynx or orbit or masticator space


# Parapharyngeal extension denotes postero-lateral infiltration of tumor beyond the pharyngo-basilar fascia.




Share with your friends:
1   2   3   4   5   6   7   8   9


The database is protected by copyright ©dentisty.org 2019
send message

    Main page