Head and Neck Oncology
Head and Neck Oncology
This domain tests staging, biopsy strategy, margin control, neck management, and adjuvant therapy for head and neck squamous cell carcinoma (HNSCC). The exam expects AJCC 8th edition concepts and awareness of HPV-related oropharyngeal cancer.
Core rules
- Oral cavity SCC is staged separately from HPV-positive oropharyngeal SCC; HPV testing does not change oral cavity staging.
- Surgical margins of at least 5 mm are desirable. Adjuvant radiotherapy is indicated for positive margins, extranodal extension, perineural invasion, lymphovascular invasion, and advanced T or N stage.
- A persistent neck mass in an adult warrants examination and imaging; fine-needle aspiration is preferred for diagnosis.
- Red flags include hoarseness over 6 weeks, unilateral otalgia, trismus, and nonhealing oral ulcers.
- Advanced laryngeal cancer may require total laryngectomy with adjuvant therapy; early glottic disease can be treated with radiation or conservation surgery.
Worked example
A 58-year-old has a 2 cm ulcer on the lateral tongue and a 3 cm level IB node. Biopsy confirms SCC. Imaging shows no distant disease. Management is wide local excision with margin control plus neck dissection; adjuvant radiotherapy is added if extranodal extension or positive margins are found. The reasoning is that oral cavity SCC spreads to cervical nodes and adverse pathology changes adjuvant treatment.
Traps
Do not apply HPV staging to oral cavity cancer. Do not ignore a neck node because the primary lesion is small. Do not omit documentation of margin distance. Do not treat a nonhealing oral ulcer with repeated antibiotics without biopsy.