oropharyngeal squamous cell carcinoma

TNM staging

Stages NCI

 Stage 0 (Carcinoma in Situ)

• In stage 0, abnormal cells are found in the lining of the oropharynx. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

 Stage I

In stage I, cancer has formed and is 2 centimeters or smaller and is found in the oropharynx only.

Stage II

• In stage II, the cancer is larger than 2 centimeters but not larger than 4 centimeters and is found in the oropharynx only.

• Stage III - In stage III, the cancer is either:
• 4 centimeters or smaller; cancer has spread to one lymph node on the same side of the neck as the tumor and the lymph node is 3 centimeters or smaller;
• or larger than 4 centimeters or has spread to the epiglottis (the flap that covers the trachea during swallowing).
• Cancer may have spread to one lymph node on the same side of the neck as the tumor and the lymph node is 3 centimeters or smaller.

 Stage IV

• In stage IVA, cancer:
  • has spread to the larynx, front part of the roof of the mouth, lower jaw, or muscles that move the tongue or are used for chewing. Cancer may have spread to one lymph node on the same side of the neck as the tumor and the lymph node is 3 centimeters or smaller;
  • or has spread to one lymph node on the same side of the neck as the tumor (the lymph node is larger than 3 centimeters but not larger than 6 centimeters) or to more than one lymph node anywhere in the neck (the lymph nodes are 6 centimeters or smaller), and one of the following is true:
  • tumor in the oropharynx is any size and may have spread to the epiglottis (the flap that covers the trachea during swallowing); or
  • tumor has spread to the larynx, front part of the roof of the mouth, lower jaw, or muscles that move the tongue or are used for chewing.

• In stage IVB, the tumor:
  • surrounds the carotid artery or has spread to the muscle that opens the jaw, the bone attached to the muscles that move the jaw, nasopharynx, or base of the skull.
  • Cancer may have spread to one or more lymph nodes which can be any size; or
    may be any size and has spread to one or more lymph nodes that are larger than 6 centimeters.

• In stage IVC, the tumor may be any size and has spread beyond the oropharynx to other parts of the body, such as the lung, bone, or liver.

Prognostic factors

 p16

• Outcomes for p16 positive, HPV negative oropharyngeal SCC are not significantly different from p16 positive, HPV positive tumors and are significantly better than for p16 negative tumors.
• These results suggest that p16 immunohistochemistry alone is the best test to use for risk stratification in oropharyngeal SCC. (20588174)

See also

 HPV-associated oropharyngeal squamous cell carcinoma
 p16+ oropharyngeal squamous cell carcinoma

Open references

 Competing causes of death and medical comorbidities among patients with human papillomavirus-positive vs human papillomavirus-negative oropharyngeal carcinoma and impact on adherence to radiotherapy. Hess CB, Rash DL, Daly ME, Farwell DG, Bishop J, Vaughan AT, Wilson MD, Chen AM. JAMA Otolaryngol Head Neck Surg. 2014 Apr;140(4):312-6. doi : 10.1001/jamaoto.2013.6732 PMID: 24526276 (free)

 Transcriptionally-active human papillomavirus is consistently retained in the distant metastases of primary oropharyngeal carcinomas. Mehrad M, Zhao H, Gao G, Wang X, Lewis JS Jr. Head Neck Pathol. 2014 Jun;8(2):157-63. doi : 10.1007/s12105-013-0509-1 PMID: 24271958 (Free)

References

 Tumor cell anaplasia and multinucleation are predictors of disease recurrence in oropharyngeal squamous cell carcinoma, including among just the human papillomavirus-related cancers. Lewis JS Jr, Scantlebury JB, Luo J, Thorstad WL. Am J Surg Pathol. 2012 Jul;36(7):1036-46. PMID: 22743286

 p16 positive oropharyngeal squamous cell carcinoma:an entity with a favorable prognosis regardless of tumor HPV status. Lewis JS Jr, Thorstad WL, Chernock RD, Haughey BH, Yip JH, Zhang Q, El-Mofty SK. Am J Surg Pathol. 2010 Aug;34(8):1088-96. PMID: 20588174