staging of oral carcinoma various differential diagnosis

staging of carcinoma
clinical features
signs and symptoms

1. Staging of Oral Carcinoma

2. Introduction • Oral carcinoma: malignant tumor of the oral cavity, most commonly squamous cell carcinoma. • Staging is critical for treatment planning and prognosis. • Based on TNM system (Tumor, Node, Metastasis) and clinical parameters.

3. TNM System Overview • T (Tumor): size and extent of primary tumor • N (Node): regional lymph node involvement • M (Metastasis): distant spread • Staging classifies tumors from Stage I (early) to Stage IV (advanced)

4. T (Tumor) Classification • T1: Tumor ≤ 2 cm • T2: Tumor > 2 cm but ≤ 4 cm • T3: Tumor > 4 cm • T4: Invades adjacent structures - T4a: Moderately advanced (cortical bone, maxillary sinus, skin) - T4b: Very advanced (masticator space, skull base, cranial nerves)

5. N (Node) Classification • N0: No regional lymph node metastasis • N1: Single ipsilateral node ≤ 3 cm • N2: - N2a: Single ipsilateral node >3 cm ≤6 cm - N2b: Multiple ipsilateral nodes ≤6 cm - N2c: Bilateral/contralateral nodes ≤6 cm • N3: Node > 6 cm

6. M (Metastasis) Classification • M0: No distant metastasis • M1: Distant metastasis present (lungs, liver, bone)

7. Clinical Staging (Stage I–IV) Stage I - T1 N0 M0 - Small localized tumor, no nodes, no metastasis Stage II -T2 N0 M0 - Tumor >2–4 cm, no nodes, no metastasis Stage III - T3 N0 M0 or T1-3 N1 M0 - Larger tumor or single node involvement Stage IV - T4a/b or N2/3 or M1 - Advanced local invasion, multiple nodes, or distant metastasis

8. Importance of Staging • Guides treatment planning: surgery, radiotherapy, chemotherapy • Predicts prognosis and survival • Helps compare outcomes across studies and institutions

9. Investigations for Staging • Clinical examination: size, ulceration, fixation • Imaging: CT / MRI for local extent, PET/CT for metastasis • Biopsy: histopathology confirmation • Lymph node evaluation: palpation + imaging

10. Summary • Oral carcinoma staging is based on TNM system. • Accurate staging is critical for management and prognosis. • Multidisciplinary approach ensures optimal treatment.