Oral cavity cancer

Abstract

In the course of managing a patient with carcinoma of the oral cavity, depending on the clinical situation, the clinician will have to make crucial decisions in the diagnostic evaluation and treatment of the cancer. Based on the case of a patient with a squamous cell carcinoma of the anterior-lateral floor of the mouth, staged T2N0, this chapter presents a concise, comprehensive discussion of the best evidence available to enable the reader to decide what is the best method to assess mandibular invasion, whether or not the patient should undergo panendoscopy, have and ultrasound (US) of the neck, and a CT or MRI scan of the neck, and whether or not a PET scan or a PET/CT should be obtained. Then, based on the case of a patient with a squamous cell carcinoma of the lateral border of the tongue, clinically staged T2N0, the authors discuss pertinent decisions regarding the treatment of the primary tumor, such as whether to recommend surgery or radiation, how wide a margin of normal tissue should be resected around the tumor, emphasizing the implications of having initially positive margins. Regarding management of the cervical lymph nodes, the reader will find a thorough discussion of the available evidence supporting observation of the neck, sentinel node biopsy and elective neck dissection, as well as the evidence-based indications for postoperative adjuvant therapy.