Surgical management of the N0 neck in early stage T1-2 oral cancer; a personal perspective of early and late impalpable disease.

Oral and Maxillofacial Surgery
R A Ord

Abstract

The management of the N0 neck in early stage oral cancer remains controversial. The evidence in the literature for elective neck dissection, which is reviewed in this paper, is conflicting. My personal view is that most papers mistakenly assume that the N0 equates to an "early stage" neck whereas a neck with palpable nodes represents disease at a "late" stage. I believe that this is the same mindset that prevented us from realizing that depth rather than size was the important prognostic determinant for the primary tumor; because the T stage was based on tumor size. The N stage is also based on size and number of nodes and by these criteria N0 would be the earliest stage. However, although an N0 neck with impalpable intra-nodal disease may be regarded as early impalpable disease an N0 neck with microscopic extra-capsular spread (ECS) would be "late/advanced" impalpable disease. Likewise, a clinically positive neck with intra-nodal disease still represents early disease compared to a clinically positive neck with ECS. The lack of trials and studies stratifying NO and N +ve necks into early and late disease and comparing outcomes between these cohorts may explain the lack of clear-cut evidence regarding the role for elective neck...Continue Reading

References

Sep 1, 1991·Archives of Otolaryngology--head & Neck Surgery·C R LeemansG B Snow
Feb 1, 1989·Journal of Oral Pathology & Medicine : Official Publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology·S M Saka, D G MacDonald
Oct 1, 1989·American Journal of Surgery·A R FakihA R Patel
Oct 1, 1988·American Journal of Surgery·J D SpiroE W Strong
Dec 1, 1985·Journal of Maxillofacial Surgery·S OzekiT Matsushima
Feb 16, 1995·The New England Journal of Medicine·J A BrennanD Sidransky
Nov 1, 1994·Annals of Surgical Oncology·J P Shah, P E Andersen
Nov 1, 1994·American Journal of Surgery·J KligermanL O Olivatto
Jul 1, 1994·Archives of Otolaryngology--head & Neck Surgery·M H WeissR S Isaacs
Dec 1, 1995·The Laryngoscope·C H RassekhE N Myers
Jan 1, 1996·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·A Alvi, J T Johnson
Oct 1, 1996·The Journal of Laryngology and Otology·X M LiL K Lam
Dec 1, 1996·American Journal of Surgery·D H KrausJ P Shah
Dec 1, 1996·American Journal of Surgery·P E AndersenJ P Shah
Aug 24, 1999·The British Journal of Oral & Maxillofacial Surgery·J A Woolgar
Dec 22, 1999·The Annals of Otology, Rhinology, and Laryngology·A FerlitoA Carbone
Feb 28, 2001·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·P AmbroschW Steiner
Aug 1, 2002·The Laryngoscope·Mario RussoloGiancarlo Tirelli
Aug 10, 2002·The Laryngoscope·Mario RussoloGiancarlo Tirelli
May 7, 2004·The New England Journal of Medicine·Jay S CooperUNKNOWN Radiation Therapy Oncology Group 9501/Intergroup
May 7, 2004·The New England Journal of Medicine·Jacques BernierUNKNOWN European Organization for Research and Treatment of Cancer Trial 22931
Sep 24, 2004·Archives of Otolaryngology--head & Neck Surgery·Young Chang LimEun Chang Choi
Jun 28, 2005·Critical Reviews in Oncology/hematology·Jacques BernierJay S Cooper
Jun 10, 2006·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Jacques BernierWayne M Koch
May 14, 2010·The British Journal of Oral & Maxillofacial Surgery·Joshua LubekRobert A Ord
Feb 1, 2011·International Journal of Oral and Maxillofacial Surgery·T ZhangJ Zhao
Apr 16, 2011·Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·Matthew J LinTim A Iseli

❮ Previous
Next ❯

Citations

Mar 25, 2014·Oral and Maxillofacial Surgery Clinics of North America·Jonathan W Shum, Eric J Dierks
Sep 2, 2016·Journal of Cranio-maxillo-facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery·Steffen KoerdtMarco R Kesting
Dec 5, 2019·Journal of Applied Oral Science : Revista FOB·Renata Miranda RodriguesSimone de Queiroz Chaves Lourenço

❮ Previous
Next ❯

Related Concepts

Trending Feeds

COVID-19

Coronaviruses encompass a large family of viruses that cause the common cold as well as more serious diseases, such as the ongoing outbreak of coronavirus disease 2019 (COVID-19; formally known as 2019-nCoV). Coronaviruses can spread from animals to humans; symptoms include fever, cough, shortness of breath, and breathing difficulties; in more severe cases, infection can lead to death. This feed covers recent research on COVID-19.

Blastomycosis

Blastomycosis fungal infections spread through inhaling Blastomyces dermatitidis spores. Discover the latest research on blastomycosis fungal infections here.

Nuclear Pore Complex in ALS/FTD

Alterations in nucleocytoplasmic transport, controlled by the nuclear pore complex, may be involved in the pathomechanism underlying multiple neurodegenerative diseases including Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. Here is the latest research on the nuclear pore complex in ALS and FTD.

Applications of Molecular Barcoding

The concept of molecular barcoding is that each original DNA or RNA molecule is attached to a unique sequence barcode. Sequence reads having different barcodes represent different original molecules, while sequence reads having the same barcode are results of PCR duplication from one original molecule. Discover the latest research on molecular barcoding here.

Chronic Fatigue Syndrome

Chronic fatigue syndrome is a disease characterized by unexplained disabling fatigue; the pathology of which is incompletely understood. Discover the latest research on chronic fatigue syndrome here.

Evolution of Pluripotency

Pluripotency refers to the ability of a cell to develop into three primary germ cell layers of the embryo. This feed focuses on the mechanisms that underlie the evolution of pluripotency. Here is the latest research.

Position Effect Variegation

Position Effect Variagation occurs when a gene is inactivated due to its positioning near heterochromatic regions within a chromosome. Discover the latest research on Position Effect Variagation here.

STING Receptor Agonists

Stimulator of IFN genes (STING) are a group of transmembrane proteins that are involved in the induction of type I interferon that is important in the innate immune response. The stimulation of STING has been an active area of research in the treatment of cancer and infectious diseases. Here is the latest research on STING receptor agonists.

Microbicide

Microbicides are products that can be applied to vaginal or rectal mucosal surfaces with the goal of preventing, or at least significantly reducing, the transmission of sexually transmitted infections. Here is the latest research on microbicides.