Staging & Grading of oral cancer

Staging and Grading
Dr.Vasanthi

1. dr vasanthi v Department of Oral Pathology & Microbiology SRM Dental College, Ramapuram , Chennai, India Staging & grading of oral cancer

2. Sixth most common cancer in the world High frequency in Central and South East Asian countries 94% of all oral malignancies are squamous cell carcinoma Most common in India- 50-70% of total cancer morbidity 75% due to tobacco chewing or smoking

3. STAGING: Staging is based on clinical, radiological, and surgical criteria such as tumor size, involvement of regional lymph nodes and presence of metastases GRADING: Grading is based on the microscopic features of the cells which compose a tumor and is specific for the tumor type

4. TNM Staging STNMP staging STAGING SYSTEMS

5. TUMOR - NODE - METASTASIS STAGING (TNM) PARAMETERS Size of the lesion Nodal involvement Spread of the tumor Pierre Denoix 1940 Universal – UICC & AJCC-TNM classification cTNM & pTNM Expected to predict Clinical course of the tumor Prognosis Treatment plan Evaluation of response to treatment

6. www.clinicalgate.com

7. S-Site of primary tumor T- Size of tumor N-Nodal involvement M-Metastasis P-Pathology of lesion STNMP STAGING

8. Broder’s system (1920) WHO system (1972) Jakobsson’s system (1973) Anneroth’s system (1987) Bryne’s IFG system (1989) Histologic risk model (2005) BD model (2014) GRADING SYSTEMS

9. BRODER’S SYSTEM (1920) Grade I - 75% differentiated cells- Well differentiated Grade II - 50 – 75% differentiated cells- Moderately differentiated Grade III - 50 – 25% differentiated cells- Poorly differentiated Grade IV -25% differentiated cells-Undifferentiated Drawbacks Lack of correlation between grading and prognosis

10. WHO SYSTEM (1972) Grade I -Well differentiated Grade II -Moderately differentiated Grade III -Poorly differentiated

11. JAKOBSSON’S SYSTEM (1973) Histological grading of tumor – host r/s Mode of invasion Stage of invasion Vascular invasion Degree of lymphoplasmacytic infiltration Histologic grading of tumor cell Structure Tendency towards keratinization Nuclear aberrations No. of mitosis

12. JAKOBSSON SYSTEM

13. ANNEROTH’S SYSTEM (1987) Modified Jakobsson’s grading system Standard method – more specific result predicts prognosis guides for treatment plan

14. ANNEROTH’S SYSTEM Malignancy grading: Grade I: 6-12 Grade II: 13-18 Grade III : 19-24

15. BRYNE’S SYSTEM (1989) Malignancy grading of deep invasive margins at invasive tumor front (ITF) ITF- correlates with tumor aggressiveness, aberrant expression of cadherins , integrins High prognostic significance Drawbacks – Inter examiner variability Most cells are immature at invasive front

16. BRYNE’S SYSTEM (1989) Malignancy grading: Grade I - 4-8 Grade II - 9-12 Grade III - 13-16

17. HISTOLOGIC RISK MODEL (2005) Proposed by Brandwein – Gesler Evaluation of surgical specimen - 3 parameters WPOI – Worst Pattern of Invasion LHR - Lymphocyte Host Response PNI - Perineural invasion Drawbacks Evaluation after surgical resection- alter treatment plan Lymphatic and blood vessel invasion – not considered

18. HISTOLOGIC RISK MODEL (2005)

19. WPOI – Worst Pattern of Invasion

20. LHR-Lymphocyte Host Response

21. PNI - Perineural invasion

22. BD Model Proposed by Almangush B- Tumor budding D-Depth of invasion Tumor thickness Represents cellular discohesion and active invasion Low risk – Budding <5 , Depth <4 mm High risk – Budding > 5 , Depth > 4 mm

23. BD Model

24. BD Model – Tumor Budding

25. PROGNOSTIC EVALUATION Tumor related factors Growth pattern Micrometastasis Extracapsular spread Host/patient related factors Age, sex, habits Immune competence Co-morbidity Likely outcome of the disease 5 year survival rate Patients with lymph node involvement 20-36% after surgery Patients without lymph node involvement 63-86%

26. Staging is important in assessing prognosis, planning treatment and advising patients accordingly. The histopathological grading systems are useful in the prognostication of cancer, distinguishing low from high risk and proper treatment planning . CONCLUSION

27. REFERENCES The Prognostic Value Of Histopathological Grading Systems In Oral Squamous Cell Carcinomas, Sawazaki-Calone et al, Oral Diseases 2015 Comparative Study Of Various Grading Systems In Oral Squamous Cell Carcinoma And Their Value In Predicting Lymph Node Metastasis, Saleha Jamadar , Tv Narayan , Balasundari Shreedhar1, Leeky Mohanty , Sadhana Shenoy , Indian Journal Of Dental Research, 25(3), 2014 Depth Of Invasion, Tumor Budding, And Worst Pattern Of Invasion: Prognostic Indicators In Early-Stage Oral Tongue Cancer, Alhadi Almangush , Head & Neck—June 2014 Clinicopathological Prognostic Factors Of Oral Tongue Squamous Cell Carcinoma: A Retrospective Study Of 202 Cases, Rodrigues Et Al, Int. J. Oral Maxillofac . Surg. 2014. A Study On Histological Grading Of Oral Squamous Cell Carcinoma And Its Corelationship With Regional Metastasis, M Akhter , S Hossain , Quazi B Rahman , And Motiur R Molla Mayaug ; J Oral Maxillofac Pathol . 2011   Lymphocytic Host Response To Oral Squamous Cell Carcinoma: An Adaptive T-Cell Response At The Tumor Interface, Sara Maleki , Head And Neck Pathol 2011. Oral cancer structured reporting protocol, rcpath.com, 2011 Correlation Between TNM Classification And Malignancy Histological Feature Of Oral Squamous Cell Carcinoma, Antonio De L. L. Costa1, Raimundo F. De Araújo Júnior2, Carlos C. F. Ramos, Rev Bras Otorrinolaringol V.71, N.2, 181-7, Mar./Apr. 2005 Future Of The TNM Classification And Staging System In Head And Neck Cancer, Robert P. Takes Et Al, Robert P. Takes.