A large squamous cell carcinoma of the tongue as seen on CT imaging Histopathologic appearance of a poorly differentiated squamous cell carcinoma specimen. Hematoxylin-eosin stain. p16 positive, EBV negative Diagnosis of<unk>  is completed for (1) initial diagnosis, (2) staging, and (3) treatment planning. A complete history, and clinical examination is first completed, then a wedge of tissue is cut from the suspicious lesion for tissue diagnosis. This might be done with scalpel biopsy, punch biopsy, fine or core needle biopsy. In this procedure, the surgeon cuts all, or a piece of the tissue, to have it examined under a microscope by a pathologist. Brush biopsies are not considered accurate for the diagnosis of<unk> . With the first biopsy, the pathologist will provide a tissue diagnosis (e.g. squamous cell carcinoma), and classify the cell structure. They may add additional information that can be used in staging, and treatment planning, such as the mitotic rate, the depth of invasion, and the HPV status of the tissue. After the tissue is confirmed<unk> ous, other tests will be completed to: *better assess the size of the lesion (CT scan, MRI or PET scan with 18F-fluorodeoxyglucose (FDG)), *look for other<unk> s in the upper aerodigestive tract (which may include endoscopy of the nasal cavity/pharynx, larynx, bronchus, and esophagus called panendoscopy or quadoscopy), *spread to the lymph nodes (CT scan) or *spread to other parts of the body (chest X-ray, nuclear medicine). Other, more invasive tests, may also be completed such as fine needle aspiration, biopsy of lymph nodes, and sentinel node biopsy. When the<unk>  has spread to lymph nodes, their exact location, size, and spread beyond the capsule (of the lymph nodes) needs to be determined, as each can have a significant impact on treatment and prognosis. Small differences in the pattern of lymph node spread, can have a significant impact on treatment and prognosis. Panendoscopy may be recommended, because the tissues of the entire upper aerodigestive tract are generally affected by the same carcinogens, so other primary<unk> s are a common<unk> currence. From these collective findings, taken in consideration with the health and desires of the person, the<unk>  team develops a plan for treatment. Since most<unk> s require surgical removal, a second set of histopathologic tests will be completed on any tumor removed to determine the prognosis, need for additional surgery, chemotherapy, radiation, immunotherapy, or other interventions. Classification<unk>  is a subgroup of head and neck<unk> s which includes those of the oropharynx, larynx, nasal cavity and paranasal sinuses, salivary glands, and thyroid gland.<unk>  melanoma, while part of head and neck<unk> s is considered separately. Other<unk> s can<unk> cur in the mouth (such as bone<unk> , lymphoma, or metastatic<unk> s from distant sites) but are also considered separately from<unk> s. Staging<unk>  staging is an assessment of the degree of spread of the<unk>  from its original source. It is one of the factors affecting both the prognosis and the potential treatment of<unk> . The evaluation of squamous cell carcinoma of the mouth and pharynx staging uses the TNM classification (tumor, node, metastasis). This is based on the size of the primary tumor, lymph node involvement, and distant metastasis. TNM classification<unk>  of the<unk>  cavity (does not apply to HPV+ or HPV-<unk> pharyngeal<unk> s) T: Primary tumor TX Primary tumor cannot be assessed Tis Carcinoma in situ T1 Tumor ≤ 2 cm with depth of invasion (DOI*) ≤5mm T2 Tumor ≤ 2 cm with DOI* >5mm or tumor >2 cm and ≤ 4 cm with DOI* ≥10mm T3 Tumor > 2 cm and ≤4 cm with DOI* > 10mm or tumor >4 cm with DOI* ≤ 10mm T4 Moderately advanced or very advanced local disease T4a Moderately advanced local disease, tumor >4 cm with DOI* >10mm or tumor invades adjacent structures only (cortical bone of the mandible or maxilla (excluding superficial erosion of tooth socket alone in gingival tumors) or involves the maxillary sinus or skin of the face) T4b Very advanced local disease. Tumor invades masticator space, pterygoid plates, or skull base and/or encases the internal carotid artery *DOI is depth of invasion and not tumor thickness. N: Clinical Lymph nodes (separate classification for pathologic classification) NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Metastasis in a single ipsilateral lymph node, 3 cm and ≤6 cm and ENE(−); or metastases in multiple ispsilateral lymph nodes, none >6 cm and ENE(−); or in bilateral or contralateral lymph nodes(s), non >6 cm ENE(−) N2a Metastasis in a single ipsilateral node M: Metastasis cM0 No distant metastasis cM1 Distant metastasis pM1 Distant metastasis, microscopically confirmed Spread of<unk>  beyond the capsule of a lymph node (ENE+). TMN evaluation allows the person to be classified into a prognostic staging group; AJCC Prognostic Stage Groups When T is... And N is... And M is... Then the stage group is... Tis N0 M0 0 T1 N0 M0 I T2 N0 M0 II T3 N0 M0 III T1,T2,T3 N1 M0 III T4a N0,N1 M0 IVA T1,T2,T3,T4a N2 M0 IVA Any T N3 M0 IVB T4b Any N M0 IVB Any T Any N M1 IVC
Oral cancer
Squamous cell carcinoma
Skin cancer
Head and neck cancer
Laryngeal cancer
Dental abscess
Salivary gland disease
Mouth ulcer