Tongue carcinoma

tongue cancer

1. Dr sumer yadavDr sumer yadav

2. INTRODUCTIONINTRODUCTION
ORAL CANCER IS FIFTH MOST COMMON ORAL CANCER IS FIFTH MOST COMMON
MALIGNANCY GLOBALLY.MALIGNANCY GLOBALLY.
WESTERN WORLD # 2 TO 4 % OF WESTERN WORLD # 2 TO 4 % OF
MALIGNANT TUMORS.MALIGNANT TUMORS.
ASIA # NOT LESS THAN 40%ASIA # NOT LESS THAN 40%
RATIO OF MEN & WOMEN 3 : 1.RATIO OF MEN & WOMEN 3 : 1.
APPROX AGE > 60 YEARSAPPROX AGE > 60 YEARS

3. SOLID CONICAL MUSCULAR ORGAN, SOLID CONICAL MUSCULAR ORGAN,
COVERED BY MUCOUS MEMBRANE, COVERED BY MUCOUS MEMBRANE,
PRESENT IN ORAL CAVITY & PRESENT IN ORAL CAVITY &
OROPHARYNX.OROPHARYNX.
ANT 2/3 ORAL TONGUE – FREELY MOBILE ANT 2/3 ORAL TONGUE – FREELY MOBILE
& ANT. TO CIRCUMVALLATE PAPILLAE& ANT. TO CIRCUMVALLATE PAPILLAE
POST 1/3 – BASE TONGUE – POST TO POST 1/3 – BASE TONGUE – POST TO
CIRCUM VALLATE PAPILLAE & CIRCUM VALLATE PAPILLAE &
PALATOGLOSSAL ARCHPALATOGLOSSAL ARCH
ANATOMIC REGION – TIP, LATERAL ANATOMIC REGION – TIP, LATERAL
BORDER, DORSUM & UNDER SURFACEBORDER, DORSUM & UNDER SURFACE
EXTRINSIC & INTRINSIC MUSCLES ARE EXTRINSIC & INTRINSIC MUSCLES ARE
PRESENT SYMMETRICALLY PRESENT SYMMETRICALLY
ANATOMYANATOMY

5. IT HELP IN MASTICATION, DEGLUTITION & IT HELP IN MASTICATION, DEGLUTITION &
SPEECHSPEECH
RELATIVELY AVASCULAR MIDLINE - RELATIVELY AVASCULAR MIDLINE -
MARKED BY MEDIAN FIBROUS SEPTUMMARKED BY MEDIAN FIBROUS SEPTUM
LINGUAL ARTRY – ECA AT Gr CORNU OF LINGUAL ARTRY – ECA AT Gr CORNU OF
HYOID BONE HYOID BONE
DEEP VEIN – LINGUAL VEIN – IJVDEEP VEIN – LINGUAL VEIN – IJV
NERVE SUPPLY – NERVE SUPPLY –
A. MOTORA. MOTOR
–ALL MUSCLE – HYPOGLOSSAL NERVEALL MUSCLE – HYPOGLOSSAL NERVE
–PALATOGLOSSAL – CRANIAL PART OF PALATOGLOSSAL – CRANIAL PART OF
SAN SAN

6. B. SENSORY B. SENSORY
–ANT 2/3 – LINGUAL NERVE & CORDA TYNPANIANT 2/3 – LINGUAL NERVE & CORDA TYNPANI
–POST 1/3 & CIRCUMVALLETE PAPILLAE – IXPOST 1/3 & CIRCUMVALLETE PAPILLAE – IX
THTH

NERVE.NERVE.
LYMPHATIC DRAINAGELYMPHATIC DRAINAGE
–ARISES FROM SUBMUCOSAL PLEXUSARISES FROM SUBMUCOSAL PLEXUS
–APICALSET – TIP & FRENULUM – SUBMENTALAPICALSET – TIP & FRENULUM – SUBMENTAL
–MARGINAL SET – SIDE OF TONGUE – MARGINAL SET – SIDE OF TONGUE –
SUBMANDIBULARSUBMANDIBULAR
–CENTRAL SET – DORSUM – JUGULODIAGASTRIC & CENTRAL SET – DORSUM – JUGULODIAGASTRIC &
OMOHYOIDOMOHYOID
–BASAL SET – POST 1/3 - JUGULODIAGASTRIC & BASAL SET – POST 1/3 - JUGULODIAGASTRIC &
OMOHYOIDOMOHYOID
IN MIDLINE FREE DECUSSATING OF LYMPHATIC IN MIDLINE FREE DECUSSATING OF LYMPHATIC
OCCUR & THEY PASSES BILATERALLYOCCUR & THEY PASSES BILATERALLY

7. TIP OF TONGUE – RICHEST LYMPHATIC TIP OF TONGUE – RICHEST LYMPHATIC
DRAINAGEDRAINAGE
PRINCIPAL NODE– JUGULO OMOHYOIDPRINCIPAL NODE– JUGULO OMOHYOID

8. CARCINOMA TONGUE IS THE SECOND CARCINOMA TONGUE IS THE SECOND
MOST COMMON SITE OF ORAL CA AFTER MOST COMMON SITE OF ORAL CA AFTER
LIPLIP
SITE WISE INCIDENCE :-SITE WISE INCIDENCE :-
–MIDDLE 1/3 OF LATERAL BORDER OF TONGUE MIDDLE 1/3 OF LATERAL BORDER OF TONGUE
- 47% - COMMONEST SITE - 47% - COMMONEST SITE
POST 1/3 -20% POST 1/3 -20%
TIP - 15% TIP - 15%
–VENTRAL SURFACE & FRENULUM - 9%VENTRAL SURFACE & FRENULUM - 9%
–DORSUM - 6.5%DORSUM - 6.5%
–FACIO – LINGUAL - 6%FACIO – LINGUAL - 6%
AGE OF PRESENTATION = 60 YEARSAGE OF PRESENTATION = 60 YEARS
MEN > WOMEN MEN > WOMEN

9. ETIOLOGYETIOLOGY
TOBACCO : TOBACCO :
90% OF PATIENTS WITH CANCER USE 90% OF PATIENTS WITH CANCER USE
TOBACCO.TOBACCO.
RISK OF CARCINOMA INCREASES WITH RISK OF CARCINOMA INCREASES WITH
AMOUNT OF TOBACCO USED & DURATION OF AMOUNT OF TOBACCO USED & DURATION OF
HABIT.HABIT.
EXPOSURE TO TOBACCO CAUSES EXPOSURE TO TOBACCO CAUSES
PROGRESSIVE SEQUENTIAL MORPHOLOGIC PROGRESSIVE SEQUENTIAL MORPHOLOGIC
CHANGES OF MUCOSA LEADING TO CHANGES OF MUCOSA LEADING TO
NEOPLASTIC TRANSFORMATION.NEOPLASTIC TRANSFORMATION.
SUCH CHANGES M/b REVERSIBLE IF SUCH CHANGES M/b REVERSIBLE IF
TOBACCO EXPOSURE IS ELIMINATED EARLY. TOBACCO EXPOSURE IS ELIMINATED EARLY.
SO IT IS A PREVENTABLE DISEASE SO IT IS A PREVENTABLE DISEASE

10. 40% OF PATIENTS WHO PERSISTED 40% OF PATIENTS WHO PERSISTED
SMOKING AFTER PRESUMABLE SMOKING AFTER PRESUMABLE
CURE OF ORAL CANCER CURE OF ORAL CANCER
DEVELOPED SECOND CANCER DEVELOPED SECOND CANCER
COMPARED TO 6% OF THOSE WHO COMPARED TO 6% OF THOSE WHO
STOPPED SMOKING STOPPED SMOKING
TOBACCO CONTAINS CARCINOGENS TOBACCO CONTAINS CARCINOGENS
THAT ACT DIRECTLY ON MUCOSATHAT ACT DIRECTLY ON MUCOSA
INCIDENCE IN WOMEN IS INCIDENCE IN WOMEN IS
INCREASING BECAUSE OF INCREASING BECAUSE OF
INCREASING HABIT OF SMOKING & INCREASING HABIT OF SMOKING &
DRINKING.DRINKING.

11. ALCOHOLALCOHOL
75-80% OF PATIENTS WITH CANCER 75-80% OF PATIENTS WITH CANCER
CONSUME ALCOHOL.CONSUME ALCOHOL.
6 TIMES > IN DRINKER THAN NON 6 TIMES > IN DRINKER THAN NON
DRINKERDRINKER
ALCOHOL ACT AS DIRECT IRRITANT ALCOHOL ACT AS DIRECT IRRITANT
& ADD NUTRITIONAL DEFICIENCY.& ADD NUTRITIONAL DEFICIENCY.
STUDY SHOWS THAT DYSPLASTIC STUDY SHOWS THAT DYSPLASTIC
CHANGES IN THE MUCOSA OF NON CHANGES IN THE MUCOSA OF NON
SMOKING ALCOHOLIC PATIENTS, SMOKING ALCOHOLIC PATIENTS,
SUGGESTING THAT ALCOHOL ITSELF SUGGESTING THAT ALCOHOL ITSELF
IS A CARCINOGEN.IS A CARCINOGEN.
PERSONS USES BOTH ALCOHOL & PERSONS USES BOTH ALCOHOL &
TOBACCO ARE AT HIGHER RISK TOBACCO ARE AT HIGHER RISK
THAN THOSE USE ONE. THAN THOSE USE ONE.

12. POOR ORAL & DENTAL POOR ORAL & DENTAL
HYGIENE.HYGIENE.
CHRONIC IRRITATION FROM CHRONIC IRRITATION FROM
SHARP TOOTH, ORAL SEPSIS, SHARP TOOTH, ORAL SEPSIS,
SPICESSPICES
SYPHILISSYPHILIS
PLUMMER-VINSON PLUMMER-VINSON
SYNDROME.SYNDROME.

13. VIT. A DEFICIENCYVIT. A DEFICIENCY
ATAXA TELANGIECTASIA, ATAXA TELANGIECTASIA,
FANCONI ANEMIAFANCONI ANEMIA
MARIJUANA = INCREASING MARIJUANA = INCREASING
INCIDENCE TO TONGUE CANCER INCIDENCE TO TONGUE CANCER
IN YOUNG MALE.IN YOUNG MALE.
VIRUS = HSV-I & HPV 2, 11, 16VIRUS = HSV-I & HPV 2, 11, 16
FRESH FRUITS & VEGETABLES FRESH FRUITS & VEGETABLES
ARE PROTECTIVE. ARE PROTECTIVE.

14. PATHOLOGYPATHOLOGY
95% OF TONGUE CANCER ARE SCC95% OF TONGUE CANCER ARE SCC
RATIO OF SCC ANT 2/3 TO POST 1/3 RATIO OF SCC ANT 2/3 TO POST 1/3
= 4:1= 4:1
OTHERS – MELANOMA, SARCOMA, OTHERS – MELANOMA, SARCOMA,
MINOR SALIVARY GLAND CANCER MINOR SALIVARY GLAND CANCER
ADENOCYSTIC CARCINOMA, ADENOCYSTIC CARCINOMA,
ADENOCARCINOMAADENOCARCINOMA
METASTATIC CA TONGUE IS RAREMETASTATIC CA TONGUE IS RARE

15. PREMALIGNANT CONDITIONPREMALIGNANT CONDITION
DEFINIT RISK OF MALIGNANT CHANGES:-DEFINIT RISK OF MALIGNANT CHANGES:-
1.1.LEUCOPLAKIALEUCOPLAKIA
2.2.ERYTHROPLAKIAERYTHROPLAKIA
3.3.CHRONIC HYPERPLASTIC CANDISIASISCHRONIC HYPERPLASTIC CANDISIASIS

16. LEUCOPLAKIALEUCOPLAKIA
WHITE PLAQUE ON MUCOSA THAT CAN WHITE PLAQUE ON MUCOSA THAT CAN
NOT BE REMOVED BY SCRAPING AND CAN NOT BE REMOVED BY SCRAPING AND CAN
NOT BE CLASSIFIED CLINICALLY OR NOT BE CLASSIFIED CLINICALLY OR
PATHOLOGICALLY AS ANY OTHER PATHOLOGICALLY AS ANY OTHER
DISEASE.DISEASE.
SMALL CIRCUMSCRIBED WHITE PLAQUESMALL CIRCUMSCRIBED WHITE PLAQUE
SMOOTH, WRINKLED WITH FISSURES SMOOTH, WRINKLED WITH FISSURES
WHITE TO YELLOWISH OR GREY WHITE TO YELLOWISH OR GREY
HOMOGENOUS OR NODULAR SPECKLEDHOMOGENOUS OR NODULAR SPECKLED
NODULAR & SPECKLED ARE MOST LIKELY NODULAR & SPECKLED ARE MOST LIKELY
TO UNDERGO MALIGNANT CHANGES TO UNDERGO MALIGNANT CHANGES

17. INCIDENCE OF MALIGNANT CHANGES INCIDENCE OF MALIGNANT CHANGES
INCREASES INCREASES WITHWITH THE AGE OF THE AGE OF
LEUCOPLAKIALEUCOPLAKIA
2.4% MALIGNANT TRANSFORMATION RATE 2.4% MALIGNANT TRANSFORMATION RATE
AT 10 YR.AT 10 YR.
4% MALIGNANT TRANSFORMATION RATE 4% MALIGNANT TRANSFORMATION RATE
AT 20 YR.AT 20 YR.
MALIGNANT TRANSFORMATION RISK MALIGNANT TRANSFORMATION RISK
INCREASES WITH THE AGE OF PATIENTSINCREASES WITH THE AGE OF PATIENTS
< 50 YR. < 50 YR. – 1%– 1%
70 - 89 YR. 70 - 89 YR. – 7.5%– 7.5%
DURING 5 YEARS
OBSERVATION

18. LEUCOPLAKIA OF FLOOR OF LEUCOPLAKIA OF FLOOR OF
MOUTH & VENTRAL SURFACE OF MOUTH & VENTRAL SURFACE OF
TONGUE HAS HIGH INCIDENCE OF TONGUE HAS HIGH INCIDENCE OF
MALIGNANCYMALIGNANCY
INDURATIONS S/o MALIGNANT INDURATIONS S/o MALIGNANT
CHANGES, INDICATION FOR CHANGES, INDICATION FOR
BIOPSYBIOPSY
TRETMENT WITH SURGICAL TRETMENT WITH SURGICAL
EXCESION OR CO2 LASEREXCESION OR CO2 LASER

20. ERYTHROPLAKIAERYTHROPLAKIA
ANY LESION OF ORAL MUCOSA THAT ANY LESION OF ORAL MUCOSA THAT
PRESENT AS BRIGHT RED VELVETY PRESENT AS BRIGHT RED VELVETY
PLAQUE THAT CAN NOT BE PLAQUE THAT CAN NOT BE
CHARACTERIZED CLINICALLY OR CHARACTERIZED CLINICALLY OR
PATHOLOGICALLY ANY OTHER DISEASEPATHOLOGICALLY ANY OTHER DISEASE
IRREGULAR & CLEARLY DEMARCATED IRREGULAR & CLEARLY DEMARCATED
FROM NORMAL EPITHELIUMFROM NORMAL EPITHELIUM
INCIDENCE OF MALIGNANT CHANGES IS INCIDENCE OF MALIGNANT CHANGES IS
17 TIME HIGHER THAN LEUCOPLAKIA17 TIME HIGHER THAN LEUCOPLAKIA
MUST BE EXCISED SURGICALLY. MUST BE EXCISED SURGICALLY.

22. OTHERS LESIONSOTHERS LESIONS
ORAL SUBMUCOUS ORAL SUBMUCOUS
FIBROSIS FIBROSIS
SYPHILITIC GLOSSITISSYPHILITIC GLOSSITIS
SIDEROPENIC SIDEROPENIC
DYSPHASIADYSPHASIA
ORAL LICHEN PLANUSORAL LICHEN PLANUS

23. PATHOLOGICAL VARIETIESPATHOLOGICAL VARIETIES
1.1.ULCERATIVEULCERATIVE
2.2.WARTY GROWTHWARTY GROWTH
3.3.INDURATED PLAQUE OR MASSINDURATED PLAQUE OR MASS
4.4.FISSUREFISSURE
ULCERATIVE VARIETY COMMONESTULCERATIVE VARIETY COMMONEST
IRREGULAR WITH EVERTED EDGES & IRREGULAR WITH EVERTED EDGES &
INDURATED BASEINDURATED BASE
WARTY GROWTH IS USUALLY WARTY GROWTH IS USUALLY
SUPERIMPOSED ON PREVIOUS SUPERIMPOSED ON PREVIOUS
LEUCOPLAKIALEUCOPLAKIA
FISSURE IS CHRONIC & FOLLOWS FISSURE IS CHRONIC & FOLLOWS
CHRONIC SUPERFECIAL GLOSSITITS OR CHRONIC SUPERFECIAL GLOSSITITS OR
SYPHILISSYPHILIS

24. MODE OF SPREADMODE OF SPREAD
LOCAL SPREAD LOCAL SPREAD
BY INFILTRATION & INVASIONBY INFILTRATION & INVASION
ANT 2/3 OF TONGUE – FLOOR OF MOUTH, ANT 2/3 OF TONGUE – FLOOR OF MOUTH,
CROSS THE MIDLINE CROSS THE MIDLINE
MANDIBLE INFILTRATION OCCUR THROUGH MANDIBLE INFILTRATION OCCUR THROUGH
ITS DENTAL SOCKET OR EDENTULOUS ITS DENTAL SOCKET OR EDENTULOUS
ALVEOLAR RIDGE, CELLS PROCEED ALONG ALVEOLAR RIDGE, CELLS PROCEED ALONG
THE ROOT OF TOOTH INTO THE THE ROOT OF TOOTH INTO THE
CANCELLOUS PART OF MANDIBLE & THAN CANCELLOUS PART OF MANDIBLE & THAN
ALONG THE MANDIBULAR CANAL.ALONG THE MANDIBULAR CANAL.
POST 1/3 OF TONGUE – TONSIL, PHARYNX, POST 1/3 OF TONGUE – TONSIL, PHARYNX,
PALATE, EPIGLOTTIS.PALATE, EPIGLOTTIS.

25. LYMPHATIC SPREAD:LYMPHATIC SPREAD:
FREQUENTLY METASTASIZES B/LFREQUENTLY METASTASIZES B/L
POST 1/3 EMBOLIC SPREAD NOT BY POST 1/3 EMBOLIC SPREAD NOT BY
PERMEATION PERMEATION
B/L SPREAD - 25%B/L SPREAD - 25%
CONTRALATRAL SPREAD - 3% CONTRALATRAL SPREAD - 3%
BLOOD SPREAD IS BLOOD SPREAD IS
RARE MOSTLY WITH POST 1/3RARE MOSTLY WITH POST 1/3

26. CLINICAL FEATURESCLINICAL FEATURES
COMMEST PRESENTATION IS PAINLESS COMMEST PRESENTATION IS PAINLESS
LUMP OR ULCER ON THE SURFACE OF LUMP OR ULCER ON THE SURFACE OF
TONGUE.TONGUE.
EXCESSIVE SALIVATION – ELDERLY MAN EXCESSIVE SALIVATION – ELDERLY MAN
SITTING IN OPD WITH FREQUENT SITTING IN OPD WITH FREQUENT
SPITTING IN TO HANDKERCHIEF .SPITTING IN TO HANDKERCHIEF .
PAIN – LATE FEATUREPAIN – LATE FEATURE
–DUE TO INVOLVEMENT OF NERVESDUE TO INVOLVEMENT OF NERVES
–LOCALISED OR REFERRED TO EARLOCALISED OR REFERRED TO EAR
–ON SWALLOWING – IN POST 1/3 TONGUE CA ON SWALLOWING – IN POST 1/3 TONGUE CA

27. DIFFICULTY IN SPEECH – POST 1/3 DIFFICULTY IN SPEECH – POST 1/3
TONGUE CANCERTONGUE CANCER
INFILTRATION OF MUSCLES & FLOOR INFILTRATION OF MUSCLES & FLOOR
OF MOUTH – ANKYLO GLOSSIAOF MOUTH – ANKYLO GLOSSIA
FETOR ORIS, BLEEDING PRESENT FETOR ORIS, BLEEDING PRESENT
DUE TO TUMOR NECROSIS & DUE TO TUMOR NECROSIS &
INFECTION.INFECTION.
TRISMUS - INVOLVEMENT OF TRISMUS - INVOLVEMENT OF
PTERYGOID MUSCLEPTERYGOID MUSCLE
MANDIBULAR ANESTHESIA – BONE MANDIBULAR ANESTHESIA – BONE
EROSION WITH INVOLMENT OF EROSION WITH INVOLMENT OF
ALVEOLAR NERVE. ALVEOLAR NERVE.

28. DIAGNOSTIC STUDYDIAGNOSTIC STUDY
CLINICAL EXAMINATION WITH HIGH INDEX OF CLINICAL EXAMINATION WITH HIGH INDEX OF
CLINICAL SUSPICION.CLINICAL SUSPICION.
BIOPSY- INCISIONAL BIOPSY OF MOST BIOPSY- INCISIONAL BIOPSY OF MOST
SUSPICIOUS PART WITH NORMAL ADJOINING SUSPICIOUS PART WITH NORMAL ADJOINING
MUCOSA IS MANDATORY BEFORE PLANNING MUCOSA IS MANDATORY BEFORE PLANNING
TREATMENT. BIOPSY CAN BE TAKEN UNDER TREATMENT. BIOPSY CAN BE TAKEN UNDER
LA.LA.
FNAC – FROM NECK NODES.FNAC – FROM NECK NODES.
ORTHOPANTOMOGRAM (OPG) OR OBLIQUE ORTHOPANTOMOGRAM (OPG) OR OBLIQUE
VIEW RADIOGRAPH OF MANDIBLE IS VIEW RADIOGRAPH OF MANDIBLE IS
EFFECTIVE INITIAL INVESTIGATION TO EFFECTIVE INITIAL INVESTIGATION TO
ASSESS MANDIBULAR INVASION. ASSESS MANDIBULAR INVASION.

29. CT SCANCT SCAN - FOR CERVICAL METASTASIS - FOR CERVICAL METASTASIS
INFILTRATION OF MANDIBLE.INFILTRATION OF MANDIBLE.
MRI – MRI – INVESTIGATION OF CHOICE FOR INVESTIGATION OF CHOICE FOR
IMAGING SOFT TISSUE INFILTRATION. CAN IMAGING SOFT TISSUE INFILTRATION. CAN
DETECT PERINEURAL INVASION. DETECT PERINEURAL INVASION.
 X-RAY – X-RAY – LIMITED VALUE D/T COMPLEXITY LIMITED VALUE D/T COMPLEXITY
OF FASICAL BONE. MAY SHOW OF FASICAL BONE. MAY SHOW
PULMONARY METASTASIS.PULMONARY METASTASIS.
ROUTINE INVESTIGATION WITH VDRL/ ROUTINE INVESTIGATION WITH VDRL/
KHANS TEST ETC.KHANS TEST ETC.
DIRECT LARYNGOSCOPY – FOR BASE OF DIRECT LARYNGOSCOPY – FOR BASE OF
TONGUE CA & TO KNOW THE FIELD TONGUE CA & TO KNOW THE FIELD
CANCERIZATION (SYNCHRONOS AND CANCERIZATION (SYNCHRONOS AND
METACHRONOUS SECOND METACHRONOUS SECOND
MALIGNANCIES)MALIGNANCIES)

30. STAGING OF TONGUE CANCERSTAGING OF TONGUE CANCER
PRIMARY TUMOR (T)PRIMARY TUMOR (T)
TxTx -- TUMOR CAN NOT BE ASSESSEDTUMOR CAN NOT BE ASSESSED
T0T0 -- NO EVIDENCE OF PNO EVIDENCE OF P
00
TUMOR TUMOR
TisTis -- CARCINOMA IN SITUCARCINOMA IN SITU
T1T1 -- GREATEST DIAMETER = GREATEST DIAMETER = ≤ 2 cm.≤ 2 cm.
T2T2 -- > 2 cm. TO 4 cm.> 2 cm. TO 4 cm.
T3T3 -- > 4 cm.> 4 cm.

31. T4T4 -- ORAL TONGUEORAL TONGUE
T4aT4a -- INVASION OF CORTICAL BONE, INVASION OF CORTICAL BONE,
DEEP EXTRINSIC MUSCLE, DEEP EXTRINSIC MUSCLE,
MAXILLARY SINUS, SKIN OF MAXILLARY SINUS, SKIN OF
FACE.FACE.
T4b T4b -- PTERYGOID PLATE SKULL PTERYGOID PLATE SKULL
BASE, INVOLVEMENT OF ICABASE, INVOLVEMENT OF ICA
T4T4 -- BASE OF TONGUEBASE OF TONGUE
T4aT4a -- LARYNX, MEDIAL PTERYGOID, LARYNX, MEDIAL PTERYGOID,
HARD PALATE, MANDIBLE HARD PALATE, MANDIBLE
T4b T4b -- LATERAL PTERYGOID, LATERAL PTERYGOID,
NASOPHARYNX , ICA,.NASOPHARYNX , ICA,.

32. LYMPH NODELYMPH NODE
Nx – REGIONAL LN CAN NOT BE ASSESSEDNx – REGIONAL LN CAN NOT BE ASSESSED
N0 – NO NODAL METASTASISN0 – NO NODAL METASTASIS
N1 – IPSILATERAL SINGLE LN N1 – IPSILATERAL SINGLE LN ≤≤ 3cm. 3cm.
N2 :N2 :
–N2A – IPSILATERAL SINGLE LN > 3cm. - 6 cm. N2A – IPSILATERAL SINGLE LN > 3cm. - 6 cm.
–N2B – IPSILATERAL MULTIPLE LN N2B – IPSILATERAL MULTIPLE LN ≤ 6 cm.≤ 6 cm.
–N2C – BILATERAL / CONTRALATERAL LN N2C – BILATERAL / CONTRALATERAL LN ≤ 6 cm.≤ 6 cm.
N3 – ANY NODE > 6 cm.N3 – ANY NODE > 6 cm.
MIDLINE NODES ARE CONSIDERED AS MIDLINE NODES ARE CONSIDERED AS
IPSILATERALIPSILATERAL

33. DISTANT METASTASISDISTANT METASTASIS
Mx Mx – – CAN NOT BE CAN NOT BE
ASSESSEDASSESSED
M0 M0 – – NO DETECTABLE NO DETECTABLE
DISTANT DISTANT
METASTASISMETASTASIS
M1 M1 – – DISTANT DISTANT
METASTASIS METASTASIS
PRESENTPRESENT

34. CLINICAL STAGING GROUPING CLINICAL STAGING GROUPING
STAGE T N M
I T1 N0 M0
II T2 N0 M0
III T1 N1 M0
T2 N1 M0
T3 NO/N1 M0
IV A T4 N0 M0
T4 N1 M0
ANY T N2 M0
IV B ANY T N3 M0
IV C ANY T ANY N M1

35. TREATMENTSTREATMENTS
CHOICE OF TREATMENT DEPENDS CHOICE OF TREATMENT DEPENDS
UPON VARIOUS FACTORS UPON VARIOUS FACTORS
SITE OF DISEASESITE OF DISEASE
STAGE OF DISEASE:STAGE OF DISEASE:
–EARLY EARLY – SURGERY – SURGERY
–INTERMEDIATE – BOTH (Surgery & RT)INTERMEDIATE – BOTH (Surgery & RT)
–ADVANCEDADVANCED – BOTH (Surgery & RT) – BOTH (Surgery & RT)

36. PREVIOUS IRRADIATIONPREVIOUS IRRADIATION
PATIENTS PHYSICAL / SOCIAL & PATIENTS PHYSICAL / SOCIAL &
PERSONAL STATUSPERSONAL STATUS
SURGEON'S EXPERIENCE & SKILLSURGEON'S EXPERIENCE & SKILL
AVAILABILITY OF TREATMENT AVAILABILITY OF TREATMENT
FACILITIESFACILITIES

37. SURGICAL TREATMENTSSURGICAL TREATMENTS
AIMs OF SURGERYAIMs OF SURGERY
COMPLETE EXCISION OF PRIMARY, COMPLETE EXCISION OF PRIMARY,
THREE DIMENSIONALLY WITH Ro THREE DIMENSIONALLY WITH Ro
(MICROSCOPICALLY CLEAR) MARGINS.(MICROSCOPICALLY CLEAR) MARGINS.
Rx OF LNRx OF LN
RECONSTRUCTION OF TISSUE LOSS TO RECONSTRUCTION OF TISSUE LOSS TO
PROVIDE RAPID HEALING, PROVIDE RAPID HEALING,
RESTORATION OF FUNCTION & RESTORATION OF FUNCTION &
APPEARANCE TO IMPROVE QUALITY OF APPEARANCE TO IMPROVE QUALITY OF
LIFE.LIFE.

38. LOCAL EXCISIONLOCAL EXCISION
PER ORAL RESECTION IN SMALL PER ORAL RESECTION IN SMALL
LESION (≤ 2cm.) LOCATED AT TIP, LESION (≤ 2cm.) LOCATED AT TIP,
LATERAL BORDER ANT 2/3 OF LATERAL BORDER ANT 2/3 OF
TONGUE THAT ARE TONGUE THAT ARE
APPROACHABLE 2 cm. MARGIN APPROACHABLE 2 cm. MARGIN
LOCALISED PREMALIGNANT LOCALISED PREMALIGNANT
LESION ARE ALSO TREATED BY LESION ARE ALSO TREATED BY
THIS METHOD. THIS METHOD.
LASER EXCESION – MINIMAL LASER EXCESION – MINIMAL
BLEED, SCAR&RAPID HEALING BLEED, SCAR&RAPID HEALING

40. PARTIAL GLOSSECTOMY WITH PARTIAL GLOSSECTOMY WITH
SPARING OF MANDIBLESPARING OF MANDIBLE
APPLICABLE FOR SMALL SUPERFICIAL WELL APPLICABLE FOR SMALL SUPERFICIAL WELL
DIFFERENTIATED LESION OF ORAL TONGUE DIFFERENTIATED LESION OF ORAL TONGUE
WHICH ARE TWO LARGE FOR LOCAL WHICH ARE TWO LARGE FOR LOCAL
EXCISION & TUMOR NOT INVOLVING THE EXCISION & TUMOR NOT INVOLVING THE
MANDIBLE.MANDIBLE.
USUALLY DONE ALONG WITH BLOCK USUALLY DONE ALONG WITH BLOCK
DISSECTION OF NECK DISSECTION OF NECK
INCISION: MASTOID TIP TO MID LINE CHIN INCISION: MASTOID TIP TO MID LINE CHIN
TWO FINGER BELOW THE LOWER BORDER TWO FINGER BELOW THE LOWER BORDER
OF MANDIBLEOF MANDIBLE
RIGHT ANGLE TO UPPER INCISION & POST TO RIGHT ANGLE TO UPPER INCISION & POST TO
CAROTID ARTERY & DOWNWORD UP TO THE CAROTID ARTERY & DOWNWORD UP TO THE
CLAVICLE CLAVICLE

41. BLOCK DISSECTION IS BLOCK DISSECTION IS
COMPLETED TO THE LEVEL OF COMPLETED TO THE LEVEL OF
HYOID & CAROTID BIFURCATIONHYOID & CAROTID BIFURCATION
LINGUAL ARTERY IS LEGATED LINGUAL ARTERY IS LEGATED
NEAR THE HYOID NEAR THE HYOID
IPSILATERAL SUBMANDIBULAR IPSILATERAL SUBMANDIBULAR
GLAND IS SEPARATED FROM GLAND IS SEPARATED FROM
INFERIOR SURFACE OF MANDIBLEINFERIOR SURFACE OF MANDIBLE
FACIAL VESSELS ARE LIGATEDFACIAL VESSELS ARE LIGATED
LIP IS SPLIT IN MIDLINE. LIP IS SPLIT IN MIDLINE.
PERIOSTEUM IS ELEVATED FROM PERIOSTEUM IS ELEVATED FROM
EXT. SURFACE OF MANDIBLE FOR EXT. SURFACE OF MANDIBLE FOR
2 cm. IN BOTH THE DIRECTION2 cm. IN BOTH THE DIRECTION

42. INNER PERIOSTEUM ELEVATED INNER PERIOSTEUM ELEVATED
FROM SYMPHISIS TO ANGLE FROM SYMPHISIS TO ANGLE
TOOTH , LATERAL INCISOR IS TOOTH , LATERAL INCISOR IS
EXTRACTED EXTRACTED
MANDIBLE IS DIVIDED JUST OFF MANDIBLE IS DIVIDED JUST OFF
THE MIDLINE WITH GIGLI SAW.THE MIDLINE WITH GIGLI SAW.
MUCOSAL INCISION IS MADE IN MUCOSAL INCISION IS MADE IN
GINGIVO LINGUAL SULCUS GINGIVO LINGUAL SULCUS
FROM THE POINT OF FROM THE POINT OF
MANDIBULAR DIVISION TO THE MANDIBULAR DIVISION TO THE
ANT PILLARANT PILLAR

43. LEAVING 5MM OF FREE MUCOSA LEAVING 5MM OF FREE MUCOSA
ATTACHED TO MANDIBLEATTACHED TO MANDIBLE
MANDIBLE IS RETRACTED LATERALLYMANDIBLE IS RETRACTED LATERALLY
TRACTION SUTURES ARE APPLIED IN TRACTION SUTURES ARE APPLIED IN
THE TIP OF TONGUETHE TIP OF TONGUE
GLOSSECTOMY IS PERFORMED WITH GLOSSECTOMY IS PERFORMED WITH
DIATHERMY TO MAXIMIZE DIATHERMY TO MAXIMIZE
HEMOSTASIS & 2 CM MARGIN OF HEMOSTASIS & 2 CM MARGIN OF
NORMAL TONGUE IS MAINTAIND IN NORMAL TONGUE IS MAINTAIND IN
ALL DIRECTION. ALL DIRECTION.
CAUTRY INCISION IS MADE IN MIDLINE CAUTRY INCISION IS MADE IN MIDLINE
OF TONGUE FROM ANT TO POST. OF TONGUE FROM ANT TO POST.

44. ANT FROM TIP TO FLOOR &FROM ANT FROM TIP TO FLOOR &FROM
POST TURNING TO LATERALLY UP TO POST TURNING TO LATERALLY UP TO
THE ANT PILLAR.THE ANT PILLAR.
WHOLE TISSUE IS TAKEN WITH WHOLE TISSUE IS TAKEN WITH
BLOCK DISSECTION SPECIMEN. BLOCK DISSECTION SPECIMEN.
MANDIBULAR FRAGMENTS ARE MANDIBULAR FRAGMENTS ARE
REALIGNED &STABILISED WITH REALIGNED &STABILISED WITH
STEEL WIRE OR TITANEUM PLATESTEEL WIRE OR TITANEUM PLATE
TONGUE DEFECT CAN BE COVERED TONGUE DEFECT CAN BE COVERED
WITH FREE SKIN GRAFT OR PMMC WITH FREE SKIN GRAFT OR PMMC
FLAPFLAP
 WOUND IS CLOSED UNDER VACUUM WOUND IS CLOSED UNDER VACUUM
SUCTION.SUCTION.

48. MARGINAN MANDIBULECTOMYMARGINAN MANDIBULECTOMY
INDICATED IN CANCER IN CLOSE INDICATED IN CANCER IN CLOSE
PROXIMITY TO LOWER GINGIVAL OR PROXIMITY TO LOWER GINGIVAL OR
EXTENDING TO MANDIBLE WITHOUT EXTENDING TO MANDIBLE WITHOUT
CLINICAL OR RADIOLOGICAL CLINICAL OR RADIOLOGICAL
INVOLVEMENT OR WITH MINIMAL INVOLVEMENT OR WITH MINIMAL
CORTICAL INVASION.CORTICAL INVASION.
INVOLVES THE INCONTINUITY EXCESION INVOLVES THE INCONTINUITY EXCESION
OF TUMOR WITH MARGIN OF MANDIBLE OF TUMOR WITH MARGIN OF MANDIBLE
AND OVERLYING GINGIVAL.AND OVERLYING GINGIVAL.
MADIBULAR CONTINUITY IS MAINTAINED MADIBULAR CONTINUITY IS MAINTAINED
AND MUCH BETTER COSMETIC & AND MUCH BETTER COSMETIC &
FUNCTIONAL END RESULT ACHIEVED.IF FUNCTIONAL END RESULT ACHIEVED.IF
MANDIBLE IS DIRECTLY INVOLVED THAN MANDIBLE IS DIRECTLY INVOLVED THAN
SEGMENTAL MANDIBULECTOMY IS DONE.SEGMENTAL MANDIBULECTOMY IS DONE.

49. TOTAL GLOSSECTOMYTOTAL GLOSSECTOMY
INDICATED FOR MASSIVE LOCAL INDICATED FOR MASSIVE LOCAL
CARCINOMA OF TONGUE CARCINOMA OF TONGUE
LIP IS SPLIT IN MIDLINELIP IS SPLIT IN MIDLINE
B/L CHEEK FLAP ARE RAISED BEYOND B/L CHEEK FLAP ARE RAISED BEYOND
THE ANGLE OF MANDIBLETHE ANGLE OF MANDIBLE
MUCOSA IS INCISED IN BOTH MUCOSA IS INCISED IN BOTH
GINGIVO-BUCCAL SULCUS BACK TO GINGIVO-BUCCAL SULCUS BACK TO
THE ANT PILLARTHE ANT PILLAR
ASENDING RAMI OF MANDIBLE IS ASENDING RAMI OF MANDIBLE IS
DIVIDED DIVIDED
WHOLE SPECIMEN IS TAKEN OUTWHOLE SPECIMEN IS TAKEN OUT

50. K –WIRE CAN BE INSERTED FOR K –WIRE CAN BE INSERTED FOR
MANDIBLEMANDIBLE
DEFECT OF TOTAL GLOSSECTOMY DEFECT OF TOTAL GLOSSECTOMY
CONSISTS OF TONGUE, FLOOR OF CONSISTS OF TONGUE, FLOOR OF
MOUTH & SOME TISSUE PHARYNGEAL MOUTH & SOME TISSUE PHARYNGEAL
& LARYNGEAL MUCOSA.& LARYNGEAL MUCOSA.
PECTORALIS MAJOR FLAP OR PECTORALIS MAJOR FLAP OR
TEMPARAL FLAP CAN GIVE GOOD TEMPARAL FLAP CAN GIVE GOOD
RESULT.RESULT.
CARCINOMA OF BASE OF TONGUE CARCINOMA OF BASE OF TONGUE
ARE USUALLY ADVANCE & METASTIC ARE USUALLY ADVANCE & METASTIC
AT THE TIME OF PRESENTATIONAT THE TIME OF PRESENTATION

51. TREATMENT OF POST 1/3 OF TONGUE TREATMENT OF POST 1/3 OF TONGUE
IS USUALLY TELE THERAPY SINCE IS USUALLY TELE THERAPY SINCE
THE SITE IS ANATOMICALLY THE SITE IS ANATOMICALLY
DIFFICULT FOR BOTH SURGERY AND DIFFICULT FOR BOTH SURGERY AND
FOR INTERSTITIAL IRRADIATION.FOR INTERSTITIAL IRRADIATION.
MEDIAN TRANSLINGUIAL PHARYNGOTOMYMEDIAN TRANSLINGUIAL PHARYNGOTOMY
MID LINE OF TONGUE IS INCISED, MID LINE OF TONGUE IS INCISED,
BISECTING THE TONGUE IN TWO b/l BISECTING THE TONGUE IN TWO b/l
SEGMENTSEGMENT
INCISION EXTEND BACK TO THE AREA INCISION EXTEND BACK TO THE AREA
OF TUMOR IN THE BASE OF TONGUE.OF TUMOR IN THE BASE OF TONGUE.

52. TUMOR IS EXCISED & WOUND TUMOR IS EXCISED & WOUND
CAN BE CLOSED PRIMARILY.CAN BE CLOSED PRIMARILY.
MID LINE OF TONGUE IS MID LINE OF TONGUE IS
INCISED, BISECTING THE INCISED, BISECTING THE
TONGUE IN TWO b/l SEGMENTTONGUE IN TWO b/l SEGMENT
INCISION EXTEND BACK TO THE INCISION EXTEND BACK TO THE
AREA OF TUMOR IN THE BASE AREA OF TUMOR IN THE BASE
OF TONGUE.OF TONGUE.
TUMOR IS EXCISED & WOUND TUMOR IS EXCISED & WOUND
CAN BE CLOSED PRIMARILY.CAN BE CLOSED PRIMARILY.

53. TRANS HYOID PHARYNGOTOMYTRANS HYOID PHARYNGOTOMY
COLLAR INCISION IS MADE AT COLLAR INCISION IS MADE AT
HYOID LEVEL b/w THE SCM HYOID LEVEL b/w THE SCM
MUSCLES.MUSCLES.
SKIN FLAPS ELEVATEDSKIN FLAPS ELEVATED
SUPAR & INFRA HYOID SUPAR & INFRA HYOID
MUSCLES ARE EXCISED MUSCLES ARE EXCISED
CENTRAL PORTION OF HYOID CENTRAL PORTION OF HYOID
IS EXCISED.IS EXCISED.

54. TUMOR AT BASE IS EXCISED TUMOR AT BASE IS EXCISED
WITH 2 cm. MARGIN.WITH 2 cm. MARGIN.
AVOID INJURY TO LINGUAL AVOID INJURY TO LINGUAL
ARTERY & HYPOGLOSSAL ARTERY & HYPOGLOSSAL
NERVE.NERVE.
DEFECT IS CLOSED PRIMARILY.DEFECT IS CLOSED PRIMARILY.
IF TUMOR HAS INVOLVED THE IF TUMOR HAS INVOLVED THE
EPIGLOTTIS & PART OF EPIGLOTTIS & PART OF
GLOTTIS. THEN SUPRAGLOTTIC GLOTTIS. THEN SUPRAGLOTTIC
LARYGECTOMY CAN BE DONE. LARYGECTOMY CAN BE DONE.

55. ADVANCE STAGE CARCINOMA OF ADVANCE STAGE CARCINOMA OF
TONGUE REQUIRED COMBINED TONGUE REQUIRED COMBINED
MODALITY OF RADICAL SURGERY MODALITY OF RADICAL SURGERY
WITH RECONSTRUCTION WITH RECONSTRUCTION
FOLLOWED BY POST OPERATIVE RTFOLLOWED BY POST OPERATIVE RT
COMMANDO OPERATION CONSISTS COMMANDO OPERATION CONSISTS
OF COMPOSITE RESECTION OF OF COMPOSITE RESECTION OF
PRIMARY MALIGNANCY, PRIMARY MALIGNANCY,
HEMIMANDIBULECTOMY WITH HEMIMANDIBULECTOMY WITH
IPSILATERAL OR BILATERAL RND.IPSILATERAL OR BILATERAL RND.
USEFUL IN FAR ADVANCED USEFUL IN FAR ADVANCED
CARCINOMA. CARCINOMA.

59. DELEOPECTORAL SKIN FLAPDELEOPECTORAL SKIN FLAP

60. MANDIBULAR TONGUE PROSTHESISMANDIBULAR TONGUE PROSTHESIS

62. RADIO THERAPYRADIO THERAPY
RT & SURGERY HAVE EQUAL SUCCESS RT & SURGERY HAVE EQUAL SUCCESS
IN EARLY LESION. RT CAN BE GIVEN:IN EARLY LESION. RT CAN BE GIVEN:
BRACHYTHERPYBRACHYTHERPY
TELE THERAPY – EBRTTELE THERAPY – EBRT
COMBINATION THERAPYCOMBINATION THERAPY
RT MAY HELP IN ORGAN PRESERVTION RT MAY HELP IN ORGAN PRESERVTION
BUT LONG TERM COMPLICATION ARE BUT LONG TERM COMPLICATION ARE
SIGNIFICANTSIGNIFICANT
XEROSTOMIA, ERYTHEMA, SKIN XEROSTOMIA, ERYTHEMA, SKIN
SLOUGHING, ULCERATION, DENTAL SLOUGHING, ULCERATION, DENTAL
CARIES & OSTEORADIONECROSIS. CARIES & OSTEORADIONECROSIS.

63. POST OPERATIVE RT IS PREFERRED OVER POST OPERATIVE RT IS PREFERRED OVER
PRE OPERATIVE B/C OF EFFECT ON PRE OPERATIVE B/C OF EFFECT ON
WOUND HEALING WOUND HEALING
PER OPERATIVE RT: INOPERABLE, UNFIT PER OPERATIVE RT: INOPERABLE, UNFIT
FOR SURGERY& DOWN STAGINGFOR SURGERY& DOWN STAGING
POST RT IS INDICATED IN PATIENTS WITHPOST RT IS INDICATED IN PATIENTS WITH
–TT
33/T/T
4 4 PRIMARY PRIMARY
–POSITIVE SURGICAL MARGINESPOSITIVE SURGICAL MARGINES
–PERINEURAL, PERILYMPHATIC PERINEURAL, PERILYMPHATIC
VASCULAR INVASIONVASCULAR INVASION
–MIOROSCOPIC GROSS RESIDUAL TUMORMIOROSCOPIC GROSS RESIDUAL TUMOR
–EXTRA CAPSULAR SPREADEXTRA CAPSULAR SPREAD
–PATHOLOGICALLY POSITIVE LN AFTER PATHOLOGICALLY POSITIVE LN AFTER
SOHNDSOHND

64. EBRT DOSE – 6500 TO 7000 RAD TO EBRT DOSE – 6500 TO 7000 RAD TO
PRIMARY & NECK FOR CLINICALLY PRIMARY & NECK FOR CLINICALLY
EVIDENT DISEASE.EVIDENT DISEASE.
 WIDE MARGIN OF TONGUE CAN BE WIDE MARGIN OF TONGUE CAN BE
TREATEDTREATED
GIVEN AS 200 RAD PER DAY OVER 5 TO GIVEN AS 200 RAD PER DAY OVER 5 TO
7 WEEKS. 7 WEEKS.
BRACHYTHERAPHY CAN DELIVER BRACHYTHERAPHY CAN DELIVER
LARGER DOSE TO THE GIVEN TISSUE.LARGER DOSE TO THE GIVEN TISSUE.
IRIDIUM 192,CAESIUM137, NEEDLES IRIDIUM 192,CAESIUM137, NEEDLES
ARE USED. ARE USED.
IT REQUIRE ACCURATE SPACING OF IT REQUIRE ACCURATE SPACING OF
INTERSTITIAL SEEDS OR NEEDLES TO INTERSTITIAL SEEDS OR NEEDLES TO
PREVENT OVERLAPPING OF PREVENT OVERLAPPING OF
RADIATION.RADIATION.

65. PRECISE DOSIMETRY ACHIEVED BY PRECISE DOSIMETRY ACHIEVED BY
AFTER LOADING TECHNIQUE.AFTER LOADING TECHNIQUE.
RADIOACTIV SOURCE IS INSERTED IN RADIOACTIV SOURCE IS INSERTED IN
TO PREVIOUSLY IMPLANTED HOLLOW TO PREVIOUSLY IMPLANTED HOLLOW
NYLON TUBES.NYLON TUBES.
TUBES ARE PLACED UNDER GA TUBES ARE PLACED UNDER GA
AS MUCH AS 10000 RAD CAN BE AS MUCH AS 10000 RAD CAN BE
DELIVERD TO SMALL AREA WITH DELIVERD TO SMALL AREA WITH
GREATER EFFECT.GREATER EFFECT.
PROPHYLACTIC RADIATION IS DONE PROPHYLACTIC RADIATION IS DONE
B/C OE HIGH INCIDENCE OF OCCULT B/C OE HIGH INCIDENCE OF OCCULT
METASTASIS (40%). METASTASIS (40%).

66. CHEMOTHERAPYCHEMOTHERAPY
USED IN PALLIATION IN ADVDNCED USED IN PALLIATION IN ADVDNCED
CA.CA.
AGENTS ARE MTx,5-FU,CISPLATIN AGENTS ARE MTx,5-FU,CISPLATIN
BLEOMYCIN.BLEOMYCIN.
COMBINED CT IS MORE EFFECTIVE COMBINED CT IS MORE EFFECTIVE
THAN SINGLE AGENT.THAN SINGLE AGENT.
RESPONSE TO CISPLATIN+5FU RESPONSE TO CISPLATIN+5FU
OCCURE IN TWO THIRDS OF Pt OCCURE IN TWO THIRDS OF Pt
WITH COMPLETE RESPONSE IN 5-WITH COMPLETE RESPONSE IN 5-
15% 15%

67. TREATMENT OF NECKTREATMENT OF NECK
DEPEND ON NODAL STATUS.DEPEND ON NODAL STATUS.
RND IS GOLD STANDARD.RND IS GOLD STANDARD.
MRND GIVE BETTER COSMETIC & MRND GIVE BETTER COSMETIC &
FUNCTIONAL RESULT.FUNCTIONAL RESULT.
CLASSIC RND : 5 LEVEL LN WITH CLASSIC RND : 5 LEVEL LN WITH
SAN, IJV, SCM.SAN, IJV, SCM.
MRND : 5 LEVEL LN WITH MRND : 5 LEVEL LN WITH
PRESERVATION OF THE PRESERVATION OF THE
STRUCTURE.STRUCTURE.
TYPE-1 PRESERVE SAN.TYPE-1 PRESERVE SAN.
 TYPE-2 PRESERVES AN & IJV.TYPE-2 PRESERVES AN & IJV.

68. TYPE-3 PRESERVE SAN IJV TYPE-3 PRESERVE SAN IJV
&SCM.&SCM.
N-0 NECK S/B TREATED WITH N-0 NECK S/B TREATED WITH
SOHND.SOHND.
PATHOLOGICALLY POSITIVE PATHOLOGICALLY POSITIVE
NODE DETECTED ON TABLE BY NODE DETECTED ON TABLE BY
FROZEN SECTION S/B TREATED FROZEN SECTION S/B TREATED
BY RND/MRND. BY RND/MRND.
IF DECTED AFTER HPE IF DECTED AFTER HPE
FOLLOWING SOHND Pt SHOULD FOLLOWING SOHND Pt SHOULD
UNDER GO RTUNDER GO RT

70. PROGNOSISPROGNOSIS
DEPENDS ON NODAL STATUS & DEPTH OF DEPENDS ON NODAL STATUS & DEPTH OF
INVASION PERINEURAL & VASCUALR SPREAD INVASION PERINEURAL & VASCUALR SPREAD
STAGE 5 YEARS SURVIVAL
ORAL TONGUE BASE OF TONGUE
I 70% 60%
II 40% 40%
III 25% 30%
IV < 20% 15%
OVERALL SURVIVAL OF TOOUNGE CNANCER IS NEAR 50%.

71. RECURRENT DISEASERECURRENT DISEASE
WHEN A PRIMARY RECUR AFTER RT OR WHEN A PRIMARY RECUR AFTER RT OR
SURGERY CRYOSURGERY OR LASER SURGERY CRYOSURGERY OR LASER
VAPORIZATION CAN BE USED FOR VAPORIZATION CAN BE USED FOR
PALLIATION.PALLIATION.
TERMINAL EVENTSTERMINAL EVENTS
CANCER CACHEXIA & STARVATIONSCANCER CACHEXIA & STARVATIONS
INHALATION BRONCHOPNEUMONIAINHALATION BRONCHOPNEUMONIA
ASPHYXIA D/T OEDEMA OR PRESSURE ASPHYXIA D/T OEDEMA OR PRESSURE
ON AIR PASSAGE FROM A FIXED LNON AIR PASSAGE FROM A FIXED LN
EROSION OF ICA IN POST 1/3 CANCEREROSION OF ICA IN POST 1/3 CANCER
EROSION OF LINGUAL ARTRY IN ART EROSION OF LINGUAL ARTRY IN ART
2/3 CANCER2/3 CANCER