6.8.6: 6. Clinical Evaluation- History and Examination
- Page ID
- 18408
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Objectives
- Select appropriate surgery
- Avoid unnecessary surgery
- Avoid embarking on surgery that is beyond the scope of a surgeon
Primary tumour
- Site
- Diameter
- Depth of invasion (palpation)
- >4mm, then treat the neck electively
- 5-10mm: T2
- >10mm: T3
- Soft tissue invasion
- Tongue mobility
- Trismus
- XIIn, Lingual nerve, mental nerve dysfunction
- Mandible
- If adherent, then assess mandible invasion
- Dental caries if to receive radiation therapy
Cervical nodes
- Palpate the neck
- Palpate Level 1b between a finger placed on the floor of mouth and another on the neck
- To detect nodes
- To distinguish between SMG and lymph node as nodes are lateral/superficial to SMG are generally palpable only with the finger on the neck, as opposed to a SMG mass that is palpable between both fingers
- Palpable nodes in lymphatic basin: assume metastases
- No palpable nodes
- T1 <4mm depth: Watchful waiting
- T1 >4mm depth, T2-4: Electively treat neck
- Nodes outside lymphatic basin e.g. lateral cancer with contralateral nodes, then consider FNAC / nodal biopsy
Synchronous Primary (upper aerodigestive tract, lungs)
- History and office examination
- Panendocopy
- CXR / CT / PET