The document discusses the anatomy and functions of the soft palate, including its role in separating the nasopharynx from the oropharynx and in speech, swallowing, and respiratory functions. It then provides statistics on the annual incidence of oral cancer worldwide and risk factors such as tobacco, alcohol, HPV infection, and poor oral hygiene. The stages of oral cancer are described based on tumor size and spread.

7.  As a conduit for passage of air and food.
 Respiratory function (Patent pathway
between nose & larynx).
 Reflex actions (sneezing, coughing &
vomiting).
 Speech resonance.
 Deglutition.
 Drainage of mucus from nasopharynx.

9. SOFT PALATE IS A THIN MOBILE MUSCLE COMPLEX SEPARATING
NASOPHARYNX FROM OROPHARYNX

14.  Annual World wide Incidence : 10%
 Annual Incidence in US :4.8/lac
 Annual Incidence in India :31735 (males)
6956 (females)
(Globocan 2012)
 Male : Female ratio = 4:1

15.  Tobacco
 Smoking
 Alcohol
 Viruses - HPV
 Genetic factors
 Lack of certain
vitamins
 Poor oral hygiene

16.  DS DNA virus with
>150 strains
 HPV types 6, 11, 16,
and 18 are high risk
(usually 16)
 Strongest association
with oropharyngeal
carcinoma, especially
tonsillar
Large tonsillar
lesion
Histology :
Basaloid pattern
HPV-E7 probe:
HPV DNA in nearly
All neoplastic cells

18.  >90% are squamous cell carcinoma or its variants – often
poorly differentiated
 Lymphomas – 10-15% tonsil
1-2% BOT
 Malignant melanomas – 6%
 Lymphoepithelioma (tonsil & BOT) - <1.5%
 Minor salivary gland tumors
 Sarcomas
 Plasmacytomas I to IV depending on degree of
differentiation

19.  Mostly asymptomatic
 Sore throat - most frequent
 Difficulty in swallowing
 Referred otalgia
 Neck swelling
 Change in voice – Hot potato voice
 Occasionally painless mass at BOT

20.  Trismus
 Impaired deglutition
 Poor articulation
 Deep ulceration & necrosis

21.  Tumor size and extension (stage);
 Presence of palpable lymph nodes; and
location, number, and size of involved lymph
nodes
 P53 and epidermal growth factor receptor
overexpression has been associated with
increased survival .
 Histologic differentiation

23. Earliest Lesion : Red
lesions with ill defined
borders
Tonsillar pillar and
hard palate
Superior constrictor
muscle
Skull Base
Lateral wall of
nasopharynx

24.  1st to be involved : Level II
 Followed by Level III and Level IV
 At presentation : 56% are node positive
diseases
 Bilateral disease : 16%
 Incidence of occult neck disease : 20%
 Incidence of clinically positive nodes
increases with T stage

25.  The Primary tumor usually
remains in tongue unless it
begins at peripheral margin
 Primary at lateral base of
tongue
Glossopharyngeal
sulcus
Neck

26. Vallecula
Lingual surface of epiglottis
Pharyngoepiglottic fold
Ant wall of pyriform sinus
 Vallecular lesions frequently penetrate
through hyoepiglottic ligament to enter pre
epiglottic space

27.  Most common : Level II followed by Level III
and Level IV
 Level Ib may be involved if tumor extends
into oral tongue or if massive upper neck
disease in present
 At presentation : 75% are node positive
diseases
 Bilateral disease : 30%
 Incidence of occult neck disease : 40% - 50%

28.  Intially superficial lesions which progresses
to develop a central ulcer with a rolled
margin and infiltrate the palatoglossus.
 Superior : Soft palate and Hard Plate
 Antero lateral : Retromolar trigone and
buccal mucosa
 Inferomedial : Tongue
 Progression leads to involvement of bone,
skull base, nasopharynx and medial pterygoid
muscle.

29.  Initial lesion :
Exophytic with
central ulceration
 Posterior tonsillar
pillar, oropharyngeal
wall
 Base of tongue
 Parapharyngeal space
 Skull base

30.  Mostly spreads inferiorly along
Palatopharyngeal muscle to
 Middle pharyngeal constrictor
 Pharyngoepiglottic fold
 Posterior border of thyroid cartilage

31.  At presentation : 45% are node positive cases
 Ipsilateral spread : Jugular and Level Ib
nodes.
 Contralateral spread : Uncommon (5% cases).
Confined to Jugular Chain
 Incidence of occult neck disease : 10% - 15%
 Incidence of clinically positive nodes
increases with T stage

32.  At presentation : 76% are node positive cases
 Ipsilateral spread : Jugular, Junctional, Level
V, Level Ib
 Contralateral spread : Seen in 11% cases.
Confined to Jugular Chain
 Incidence of occult neck disease : 50% - 60%

34.  Routine: Blood counts , KFT and LFT.
 Diagnostic
 Detailed history and physical examination
including inspection and palpation of the lesion .
 Laryngoscopy.
 CT scan of Head and neck .
 Biopsy from the primary lesion and
 Aspiration cytology from involved lymph node if
present .
 Metastatic:
 Chest x ray/CT Chest
 USG whole abdomen

40.  Standard in delineating extent of tumor
 Evaluation of LN status
 Depth of tumor penetration
 Evaluating involvement of mandible or extension into
base of skull
 Extracapsular extension
 For treatment planning

41.  Primary Tumors : Contrast enhancing masses,
distorting normal anatomic relationships.
 Pathological Lymph Nodes : Enlarged,
enhanced with contrast, having a necrotic
centre.
 Extracapsular extension : Irregular nodal
margin without clear distinction with
surrounding fat or when there is thickening of
surrounding fibroadipose tissue or muscle.

43.  Superior soft tissue contrast
 Sensitive in detecting tumor extension and LN
distribution
 MRI is useful in patients with compromised
renal function, who are not able to receive
contrast for CT

46.  T1Tumor ≤2 cm in greatest dimension
 T2Tumor >2 cm but not >4 cm in greatest
dimension
 T3Tumor >4 cm in greatest dimension
 T4aTumor invades the larynx, deep/extrinsic
muscle of the tongue, medial pterygoid, hard
palate, or mandible
 T4bTumor invades lateral pterygoid muscle,
pterygoid plates, lateral nasopharynx, or
skull base or encases carotid artery

48.  N0: No regional Lymph node metastasis
 N1: Metastasis in single ipsilateral node
<=3cm
 N2
 N2a: Metastasis in single ipsilateral node
>3cm but < 6cm
 N2b: Metastasis in multiple ipsilateral nodes
>3cm but < 6 cm
 N2c: Metstasis in bilateral or contralateral
lymph nodes, none > 6cm
 N3: Metastasis in a lymph node >6 cm.

50.  MX: Distant metastasis cannot be evaluated.
 M0: Cancer has not spread to other parts of
the body.
 M1: Cancer has spread to other parts of the
body