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Surgery

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Thyroid & Adrenal

Question
87 out of 99
 

Patient has Carcinoma of right tongue, in the lateral aspect with lymph node of size 4cm in level 3 on the left side of the neck, what is the stage?



A No
B N1
C N2
D N3

Ans. C N2 (REF. SCHWARTZ SURGERY 8TH EDITION PG 523-531)

a. LEVEL I: This consists of the submental group of lymph nodes within the triangle bounded by the anterior bellies of digastric and the hyoid bone and the submanidbular group of nodes bounded by the posterior belly of digastric and the body of the mandible.

b. LEVEL II : Upper jugular group: This consists of the lymph nodes located around the upper third of the internal jugular vein and adjacent spinal accessory nerve extending from the level of the carotid bifurcation to the skull base.

c. LEVEL III: Middle jugular group: This consists of lymph nodes located around the middle third of the internal jugular vein extending from the carotid bifurcation superiorly to the cricothyroid membrane inferiorly.

d. LEVEL IV: Lower jugular group: This consists of the lymph nodes located around the lower third of the internal jugular vein extending from the cricothyroid membrane to the clavicle inferiorly.

e. LEVEL V: Posterior triangle group: These nodes are located along the lower half of the spinal accessory nerve and the transverse cervical artery. The supraclavicular nodes are also included in this group. The posteriorboundary is the anterior border of the trapezius and the anterior boundary is the posterior border of the sternomastoid muscle.

f. LEVEL VI: Anterior compartment group: This consists of lymph nodes surrounding the midline visceral structures of the neck extending from the hyoid bone superiorly to the suprasternal notch inferiorly. The lateral boundary on each side is the medial border of the sternomastoid. It contains the pretracheal, the paratracheal, and the perilaryngeal and precricoid lymph nodes.

Incidence of Occult Nodes

Pyriform sinus

40%

Base of tongue

20%

Supraglottic larynx

15%

Transglottic

10%

Glottic with a fixed cord

5%

TNM staging of oral and or pharyngeal cancer primary site (T)

Tx -Maximum requirements to assess tumour not metastasis

T0 - No evidence of primary tumour

Tis -Carcinoma in situ

T1 - Greatest diameter of primary tumour < 2cm

T2 -Greatest diameter of primary tumour < 4cm

T3 -Greatest diameter of primary tumour> 4 cm

T4 - Massive tumor> 4 cm in diameter with deep invasion to involve antrum, pterygoid muscles, root of tongue, or skin of neck

Nodal involvement (N)

Nx -Minimum requirements to assess regional nodes not met

N0 -No clinically positive nodes

N1 Single, clinically positive homolateral node < 3cm in diameter

N2 Metastasis in a single ipsilateral lymph node> 3cm but <6cm in greatest dimension, or multiple ipsilateral lymph nodes < 6cm in greatest dimension

N2a Metastasis in a single ipsilateral lymph node> 3cm but < 6cm in greatest dimension

N2b - Metastasis in multiple ipsilateral lymph node <6cm in greatest dimension

N2c -Metastasis in bilateral or contralateral lymph nodes <6em in greatest dimension

N3 - Metastasis in a lymph node> 6cm in greatest dimension.

Metastasis (M)

MO No metastases present

M1 Metastases clinically demonstrable

Stage grouping

Stage I T1 , N0, M0

Stage II T2, N0, M0

Stage III T3, N0,M0

T10r T2 or T3,N1, M0

Stage IV T4,N0, or N1, M0

Any T, N2 or N3, M0

Any T, any N, M1

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