2
Key Points
➤ Although anatomically adjacent to one another, accumulating data
suggests that, in many ways, squamous cell carcinoma of oral cavity
(SCCOC) and oropharynx (SCCOP) may be distinct diseases from a
biological perspective.
➤ Oral SCC is predominately associated with tobacco and betel nut
use. On the other hand, SCCOP is increasing in incidence in recent
decades due to chronic latent infections of the human papillomavirus
(HPV) and appears to disproportionately affect younger people.
➤ The majority of patients with SCCOP have node-positive (cN+)
necks at presentation, and 10-40% of patients without cN+ necks at
presentation will have occult nodal metastases in both SCCOC and
SCCOP. As such, management of the neck is a critical component of
high quality oncologic care of these patients.
Oral Cavity
Recommendation 1.1a
➤ For patients with oral cavity SCC classified as cT2-cT4, cN0 (i.e. no
clinical nor radiographic evidence of metastatic spread to the neck)
and treated with curative-intent surgery, an ipsilateral elective neck
dissection should be performed. (Strong Recommendation; EB-H-B)
Recommendation 1.1b
➤ For patients with oral cavity SCC classified as cT1, cN0, an ipsilateral
elective neck dissection should be performed. Alternatively, for
selected highly reliable patients with cT1, cN0, close surveillance
may be offered by a surgeon in conjunction with specialized neck
ultrasound surveillance techniques. (Strong Recommendation; EB-I-B)
Recommendation 1.2a
➤ For patients with a cN0 neck, an ipsilateral elective neck dissection
should include nodal levels, Ia, Ib, II, and III. An adequate dissection
should include at least 18 lymph nodes.
(Strong Recommendation; EB-H-B)
Treatment
