Tongue cancer staging

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2] Mohammed Abdelwahed M.D [3] Roukoz A. Karam, M.D.[4]

Overview

According to the TNM staging system by the American Joint Committee on Cancer, there are four stages of oral cancer based on the tumor size, lymph nodes involved, and metastasis.^[1]^[2]

Staging

A common staging system is used for all squamous cell carcinomas of the oral cavity, with tumor staging being based on size and extension into adjacent structures. Nodal staging is the same as that used for squamous cell carcinomas of the oral cavity, oropharynx, hypopharynx and larynx.^[1] The following features are assessed on either CT or MRI:^[3]

Size of tumor and tumor thickness
Extension across the midline
Extension beyond the intrinsic muscles of the tongue
Involvement of adjacent structures
- Neurovascular bundle and submandibular duct in the floor of mouth
- Mandible

T Categories for tongue cancer


T Classification	Thickness

TX	Primary tumor cannot be assessed
T0	No evidence of a primary tumor
Tis	Carcinoma in situ
T1	Tumor ≤2 cm in greatest dimension
T2	Tumor >2 cm but ≤4 cm in greatest dimension
T3	Tumor >4 cm in greatest dimension
T4a	Moderately advanced local disease (Lip) Tumor invades through cortical bone, inferior alveolar nerve, floor of mouth, or skin of face, that is, chin or nose (Oral cavity) Tumor invades adjacent structures only (e.g., through cortical bone [mandible or maxilla] into deep [extrinsic] muscle of tongue [genioglossus, hyoglossus, palatoglossus, and styloglossus], maxillary sinus, or skin of face) b
T4b	Very advanced local disease. Tumor invades masticator space, pterygoid plates, or skull base and/or encases internal carotid artery

b Mucosal extension to lingual surface of epiglottis from primary tumors of the base of the tongue and vallecula does not constitute invasion of larynx.

N Categories for tongue cancer b

Lymphatic drainage of the tongue is extensive, accounting presumably for the high rate of nodal metastases present at the time of diagnosis. Drainage patterns depend on the location of the primary lesion:

Anterior tongue: level Ia nodes (submental nodes)
Lateral tongue
Level Ib nodes: submandibular

Level II nodes: upper jugulodigastic nodes
Potentially drain directly to level IV nodes
Posterior tongue: level II nodes (upper jugulodigastic nodes)

It is important to remember that significant lymphatic drainage occurs across the midline, and thus the nodes of both sides of the neck need to be carefully examined for presence of nodal metastases. The incidence of lymph node metastases correlates with tumor thickness, which is best assessed on coronal images


N Classification	Nodal Mass

NX	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Metastasis in a single ipsilateral lymph node, ≤3 cm in greatest dimension
N2	Metastasis in a single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension Metastases in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension Metastases in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension
N2a	Metastasis in single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension
N2b	Metastases in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension
N2c	Metastases in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension
N3	Metastasis in a lymph node >6 cm in greatest dimension

b Metastases at level VII are considered regional lymph node metastases

M Categories for tongue cancer


M Classification	Definition

M0	No distant metastasis
M1	Distant metastasis

Stages of tongue cancer


Stage	T	N	M

Stage 0	Tis	N0	M0
Stage I	T1	N0	M0
Stage II	T2b	N0	M0
Stage III	T3 T2 T1 T3	N0 N1 N1 N1	M0 M0 M0 M0
Stage IVA	T4a T4a T1 T2 T3 T4a	N0 N1 N2 N2 N2 N2	M0 M0 M0 M0 M0 M0
Stage IVB	Any T T4b	N3 Any N	M0 M0
Stage IVC	Any T	Any N	M1

References

↑ ^1.0 ^1.1 Ahuja, Anil (2003). Imaging in head and neck cancer : a practical approach. London San Francisco: Greenwich Medical Media. ISBN 1841100900.
↑ Edge, Stephen (2010). AJCC cancer staging manual. New York: Springer. ISBN 0387884408.
↑ Sigal R, Zagdanski AM, Schwaab G, Bosq J, Auperin A, Laplanche A; et al. (1996). “CT and MR imaging of squamous cell carcinoma of the tongue and floor of the mouth”. Radiographics. 16 (4): 787–810. doi:10.1148/radiographics.16.4.8835972. PMID 8835972.

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[radio-1] 1.0 ^1.1 Ahuja, Anil (2003). Imaging in head and neck cancer : a practical approach. London San Francisco: Greenwich Medical Media. ISBN 1841100900.

[radio1-2] Edge, Stephen (2010). AJCC cancer staging manual. New York: Springer. ISBN 0387884408.

[pmid8835972-3] Sigal R, Zagdanski AM, Schwaab G, Bosq J, Auperin A, Laplanche A; et al. (1996). “CT and MR imaging of squamous cell carcinoma of the tongue and floor of the mouth”. Radiographics. 16 (4): 787–810. doi:10.1148/radiographics.16.4.8835972. PMID 8835972.

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