Staging of Oral Cancer

  • Ashley Hay
  • Jatin ShahEmail author
Part of the Textbooks in Contemporary Dentistry book series (TECD)


Cancer staging is an integral part of cancer care, from selection of therapy to reporting outcomes. The TNM staging system first introduced in 1958 is accepted by AJCC and UICC. The 8th edition of the AJCC/UICC staging manual introduces major changes to how oral cavity cancers are staged. Two significant changes were the introduction of depth of invasion (DOI) in determining the T stage of primary tumors and extra-nodal extension (ENE).


  1. 1.
    Global Burden of Disease Cancer C, Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 Cancer Groups, 1990 to 2015: a systematic analysis for the Global Burden of Disease Study. JAMA Oncol. 2017;3(4):524–48.CrossRefGoogle Scholar
  2. 2.
    International Union Against Cancer (UICC) Committee on Clinical Stage Classification and Applied Statistics. Clinical stage classification and presentation of results, maligant tumours of the breast and larynx. Paris; 1958.Google Scholar
  3. 3.
    International Union Against Cancer (UICC). TNM classification of malignant tumours. Geneva; 1968.Google Scholar
  4. 4.
    American Joint Committee on Cancer Staging End Results Reporting American Cancer Society National Cancer Institute. Manual for staging of cancer 1977. Chicago: American Joint Committee for Cancer Staging and End-Results Reporting American Joint Committee for Cancer Staging and End-Results Reporting; 1977. 183 p. ill.; 28 cm. p.Google Scholar
  5. 5.
    Amin MB, American Joint Committee on Cancer. AJCC cancer staging manual. 8th ed. Chicago: American Joint Committee on Cancer/Springer; 2017.CrossRefGoogle Scholar
  6. 6.
    Edge SB, American Joint Committee on C, American Cancer S. AJCC cancer staging handbook : from the AJCC cancer staging manual. 7th ed. New York: Springer; 2010. xix, 718 p. : ill. (some col.); 21 cm. p.Google Scholar
  7. 7.
    Sobin LH, Sobin LH, Gospodarowicz MK, Wittekind C, International Union against C. TNM classification of malignant tumours. 7th ed. Chichester/West Sussex/Hoboken: Wiley-Blackwell; 2010. xx, 309 pages ; 18 cm. p.Google Scholar
  8. 8.
    Brierley J, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. 8th ed. Oxford: Wiley-Blackwell; 2017.Google Scholar
  9. 9.
    Groome PA, Schulze K, Boysen M, Hall SF, Mackillop WJ. A comparison of published head and neck stage groupings in carcinomas of the oral cavity. Head Neck. 2001;23(8):613–24.CrossRefGoogle Scholar
  10. 10.
    Barnes L, Universitèats-Spital Zurich. Dept P, International Academy of P, World Health O, International Agency for Research on C. Pathology and genetics of head and neck tumours. Lyon: IARC Press; 2005. 430 p: ill. (some col.) ; 27 cm. p.Google Scholar
  11. 11.
    Spiro RH, Strong EW, Shah JP. Classification of neck dissection: variations on a new theme. Am J Surg. 1994;168(5):415–8.CrossRefGoogle Scholar
  12. 12.
    Liu J, Ebrahimi A, Low TH, Gao K, Palme CE, Sydney C, et al. Predictive value of the 8th edition American Joint Commission Cancer (AJCC) nodal staging system for patients with cutaneous squamous cell carcinoma of the head and neck. J Surg Oncol. 2017;117:765.CrossRefGoogle Scholar
  13. 13.
    Spiro RH, Huvos AG, Wong GY, Spiro JD, Gnecco CA, Strong EW. Predictive value of tumor thickness in squamous carcinoma confined to the tongue and floor of the mouth. Am J Surg. 1986;152(4):345–50.CrossRefGoogle Scholar
  14. 14.
    Pentenero M, Gandolfo S, Carrozzo M. Importance of tumor thickness and depth of invasion in nodal involvement and prognosis of oral squamous cell carcinoma: a review of the literature. Head Neck. 2005;27(12):1080–91.CrossRefGoogle Scholar
  15. 15.
    Shim SJ, Cha J, Koom WS, Kim GE, Lee CG, Choi EC, et al. Clinical outcomes for T1-2N0-1 oral tongue cancer patients underwent surgery with and without postoperative radiotherapy. Radiat Oncol. 2010;5:43.CrossRefGoogle Scholar
  16. 16.
    Murthy SP, Thankappan K, Jayasankaran SC, Milind K, Prasad C, Balasubramanian D, et al. “Deep extrinsic muscle involvement” is a fallacy in the American Joint Committee on Cancer’s seventh edition of tumor staging of oral cavity cancers. J Oral Maxillofac Surg. 2018;76(1):206–12.CrossRefGoogle Scholar
  17. 17.
    Matos LL, Dedivitis RA, Kulcsar MAV, de Mello ES, Alves VAF, Cernea CR. External validation of the AJCC Cancer staging manual, 8th edition, in an independent cohort of oral cancer patients. Oral Oncol. 2017;71:47–53.CrossRefGoogle Scholar
  18. 18.
    International Consortium for Outcome Research in H, Neck C, Ebrahimi A, Gil Z, Amit M, Yen TC, et al. Primary tumor staging for oral cancer and a proposed modification incorporating depth of invasion: an international multicenter retrospective study. JAMA Otolaryngol Head Neck Surg. 2014;140(12):1138–48.CrossRefGoogle Scholar
  19. 19.
    Patel SG, Amit M, Yen TC, Liao CT, Chaturvedi P, Agarwal JP, et al. Lymph node density in oral cavity cancer: results of the International Consortium for Outcomes Research. Br J Cancer. 2013;109(8):2087–95.CrossRefGoogle Scholar
  20. 20.
    Shaw RJ, Lowe D, Woolgar JA, Brown JS, Vaughan ED, Evans C, et al. Extracapsular spread in oral squamous cell carcinoma. Head Neck. 2010;32(6):714–22.PubMedGoogle Scholar
  21. 21.
    Wreesmann VB, Katabi N, Palmer FL, Montero PH, Migliacci JC, Gonen M, et al. Influence of extracapsular nodal spread extent on prognosis of oral squamous cell carcinoma. Head Neck. 2016;38(Suppl 1):E1192–9.CrossRefGoogle Scholar
  22. 22.
    Myers JN, Greenberg JS, Mo V, Roberts D. Extracapsular spread. A significant predictor of treatment failure in patients with squamous cell carcinoma of the tongue. Cancer. 2001;92(12):3030–6.CrossRefGoogle Scholar
  23. 23.
    Prabhu RS, Magliocca KR, Hanasoge S, Aiken AH, Hudgins PA, Hall WA, et al. Accuracy of computed tomography for predicting pathologic nodal extracapsular extension in patients with head-and-neck cancer undergoing initial surgical resection. Int J Radiat Oncol Biol Phys. 2014;88(1):122–9.CrossRefGoogle Scholar
  24. 24.
    Lydiatt WM, Patel SG, O’Sullivan B, Brandwein MS, Ridge JA, Migliacci JC, Loomis AM, Shah JP. Head and neck cancers—major changes in the American Joint Committee on cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017;67:122–37.CrossRefGoogle Scholar
  25. 25.
    Richard et al. Jatin Shah’s head and neck surgery and oncology. 5th ed. Elsevier; 2020.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.University of EdinburghEdinburghUK
  2. 2.Memorial Sloan Kettering Cancer CenterNew YorkUSA

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