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Pattern of invasion The pattern of invasion refers to the shape of the advancing front or border of the tumour. Like tumour grade/di ff erentiation, it is of important prognostic value. The UK Royal College of Pathologists recommends the grading of patter...

Perineural invasion While there is no clear consensus on the criteria for diagnos ing PNI, it is generally described as being present if at least one-third of the circumference of a nerve is surrounded by tumour cells and/or if deposits of tumour are found...

Prognostic stage groupings The eighth edition AJCC stage groupings are outlined in Table 53.3 . - - 0.8 0.6 0.4 Cumulative survival T1 0.2 T2 T3 T4 0.0 0 10 20 30 40 50 60 Time (months) No. of patients 0 12 24 36 48 60 T1 429 376 313 262 222 179 T2 564 460 345...

REFERENCES 1 Coelho KR. Challenges of the oral cancer burden in India. J Cancer Epidemiol 2012; 2012 : 701932. 2 Warnakulasuriya S, Ariyawardana A. Malignant transformation of oral leukoplakia: a systematic review of observational studies. J Oral Pathol Med ...

Reconstruction Reconstruction following tumour ablation is a key component in the management of OCSCC. Decision making with regards to reconstruction should not influence the ablative procedure. Notwithstanding the importance of facial aesthetics, preser - vat...

Regional variations Oral cancer is one of the most common cancers in India, 1 with an age-adjusted incidence rate of 20 per 100 /uni00A0 000. The disease accounts for over one-third of all cancers in India. In contrast to western populations, cancers of the ...

Risk factors Tobacco, alcohol and betel quid (areca nut, catechu, slaked lime wrapped in a piper betel leaf) are long-established risk factors for oral cavity squamous cell carcinoma (OCSCC). There is a dose–response relationship between the use of Guido Fanco...

STAGING Staging is required to document tumour size, location and disease extent, as well as to formulate a treatment plan and - facilitate discussion of prognosis with the patient. Additionally , it is an important tool for comparative outcome reporting. The...

SURGICAL MANAGEMENT Surgery , with adjuvant radiotherapy (or chemoradiotherapy) if indicated, remains the mainstay for management of oral cavity cancer. Over time, surgical techniques have evolved to become more refined with a greater emphasis on function-spar...

T stage The size and extent of tumours are typically determined by thorough clinical examination (supported by examination under anaesthesia [EUA] where necessary) and by radio - graphic assessment with cross-sectional imaging (e.g. computed tomography [CT], ...

The neck All levels of the neck must be palpated thoroughly , to assess for lymphadenopathy . However, it is important to note that, along with clinical examination, cross-sectional imaging of the neck is also required. Clinical examination without imaging h...

Tumour grade (differentiation) Often cited as an important prognosticator, the ‘WHO grade’ is based on Broders’ original classification and includes well (G1), moderate (G2) or poorly di ff erentiated (G3) grading. The grade is essentially based on how similar t...

Tumour thickness and depth of invasion Tumour thickness is measured as the maximum vertical dimension between the tumour surface and the deepest point of invasion. Although frequently used interchangeably with DOI, it is the latter that carries greater import...

Acute necrotising sialometaplasia This usually occurs on the palate and primarily a ff ects the minor salivary glands. It initially presents as a swelling that goes on to develop a central crater with rolled out margins, mimicking a malignant ulcer. Clinically ...

Benign tumours Pleomorphic adenoma These are the most common benign salivary gland tumours. They can occur at all ages, but are most commonly seen between the third and sixth decade. The average age of presentation is 45 years and they are more frequently see...

CLINICAL ANATOMY AND EMBRYOLOGY The parotid, submandibular and sublingual glands are three paired glands whereas there are innumerable minor salivary glands ( Figure 54.1 ). The glandular architecture is essentially a series of ducts that open into the oral c...

COMMON DISORDERS COMMON DISORDERS

Cytology Fine-needle aspiration cytology Fine-needle aspiration cytology (FNAC) is a widely available, simple and relatively safe diagnostic tool. It is used in the clinical setting of mass-forming lesions, often performed under ultrasound guidance. It can di...