Читать книгу Essential Cases in Head and Neck Oncology - Группа авторов - Страница 30

 Evaluation of oral cavity cancer starts with a biopsy and typically a CT scan of the face and neck with IV contrast to assess the extent of the primary lesion and to evaluate for regional lymphadenopathy. An MRI may be indicated if there is concern for significant perineural invasion, deep tongue invasion, or extension near the orbit, skull base, or parapharyngeal space. The use of PET/CT should be in patients with stage III or IV disease.

 Management of tumors of the oral cavity typically involves upfront surgery with removal of the primary tumor with clear surgical margins. A neck dissection should be performed for pathologic lymphadenopathy. Contralateral selective neck dissections should be performed if the tumor crosses the midline.

 Adjuvant radiation therapy should be considered for advanced primary tumors, the presence of lymph node metastases, perineural invasion, lymphovascular invasion, or close surgical margins.

 Adjuvant chemoradiation therapy should be recommended in instances of positive surgical margins and/or the presence of extracapsular spread in cervical lymph nodes.