eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Head & Neck Surgery

Malignant Tumors of the Palate: Workup

Author: Nader Sadeghi, MD, FRCS(C), Associate Professor of Surgery, Director of Head and Neck Surgery, Division of Otolaryngology, George Washington University
Coauthor(s): Khalid Al-Sebeih, MD, FRCSC, Fellow, Department of Otolaryngology, Kuwait University Faculty of Medicine
Contributor Information and Disclosures

Updated: Jul 9, 2008

Workup

Imaging Studies

  • Radiologic evaluation helps to increase the accuracy of staging. Computed tomography (CT) scanning and magnetic resonance imaging (MRI) are the imaging modalities of choice.
  • Perform CT scanning in axial and coronal planes. Coronal images (see Image 3) are best for assessing bony invasion of the palate and extension into the nasal fossa or maxillary sinus.
    • CT scanning aids in assessing skull-base extension. Enlargement of skull-base foramina is indicative of tumor invasion. Axial images aid in assessing extension in the horizontal plane along the soft palate, pterygoid plates and muscles, infratemporal fossa, and masticator space.
    • CT scanning with intravenous contrast infusion should include the neck to assess for cervical node involvement. This is especially important for SCC and high-grade mucoepidermoid carcinoma.
    • MRI (see Images 4-5) is more accurate for assessing perineural extension along the foramina. This is especially important in adenoid cystic carcinoma with the propensity for perineural invasion.
    • In advanced tumors with paranasal sinus involvement, MRI is superior to CT scanning in distinguishing inflammatory disease from a neoplasm.
    • For extensive lesions with intracranial involvement, MRI aids in assessing dural invasion.
  • Perform chest radiography to assess for pulmonary metastasis, a second primary site, or both.
  • A liver function test is adequate to assess for liver metastasis. Consider CT scanning of the abdomen and chest if distant metastasis is highly probable.

Diagnostic Procedures

  • Biopsy of an ulcerative lesion may be easily obtained in the office transorally using biopsy forceps with the patient under local anesthesia. Alternatively, fine-needle aspiration cytology studies may be performed if an experienced cytopathologist is available.
    • For ulcerative lesions, obtaining a biopsy specimen from closer to the edge of the tumor is important to avoid the necrotic central component.
    • In large, nonulcerated palatal lumps, an incision through the intact mucosa may be required prior to biopsy. Place the biopsy incision in a manner that allows for subsequent removal of the biopsy scar in continuity with the tumor.
    • Smaller submucosal lesions may be managed with excisional biopsy. If the pathology results indicate malignancy, further treatment is initiated.

Staging

Perform staging of the tumor according to the American Joint Committee on Cancer staging protocol because this is of critical importance to the patient's prognosis. Tumor and nodal status for oral cavity and oropharynx tumors are used for staging. Staging for cancer of the oropharynx and oral cavity, adapted from the 2002 American Joint Committee on Cancer, is as follows:

  • Staging of primary tumor (T)
    • TX - Primary tumor not assessable
    • T0 - No evidence of primary tumor (T is carcinoma in situ.)
    • T1 - Tumor 2 cm or smaller in greatest dimension
    • T2 - Tumor larger than 2 cm but not larger than 4 cm in greatest dimension
    • T3 - Tumor larger than 4 cm in greatest dimension
    • T4 - Tumor invades adjacent structures (eg, through cortical bone, soft tissues of neck, deep [extrinsic] muscle of tongue)
  • Staging of regional lymph nodes (N)
    • NX - Regional lymph nodes not assessable
    • N0 - No regional lymph node metastasis
    • N1 - Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension
    • N2 - Metastasis in a single ipsilateral lymph node, larger than 3 cm but not larger than 6 cm in greatest dimension; in multiple ipsilateral lymph nodes, none larger than 6 cm in greatest dimension; or in bilateral or contralateral lymph nodes, none larger than 6 cm in greatest dimension
    • N2a - Metastasis in a single ipsilateral lymph node larger than 3 cm but not larger than 6 cm in greatest dimension
    • N2b - Metastasis in multiple ipsilateral lymph nodes, none larger than 6 cm in greatest dimension
    • N2c - Metastasis in bilateral or contralateral lymph nodes, none larger than 6 cm in greatest dimension
    • N3 - Metastasis in a lymph node larger than 6 cm in greatest dimension
  • Staging of distant metastasis (M)
    • MX - Presence of distant metastasis cannot be assessed
    • M0 - No distant metastasis
    • M1 - Distant metastasis

More on Malignant Tumors of the Palate

Overview: Malignant Tumors of the Palate
Workup: Malignant Tumors of the Palate
Treatment: Malignant Tumors of the Palate
Follow-up: Malignant Tumors of the Palate
Multimedia: Malignant Tumors of the Palate
References
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References

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Further Reading

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Keywords

malignant palate tumor, squamous cell carcinoma, SCC, nonsquamous cell cancer, non-squamous cell cancer, non-SCC, minor salivary gland cancer, sarcoma, melanoma, soft palate cancer, soft palate carcinoma, palate cancer, palate carcinoma, hard palate cancer, hard palate carcinoma, oral cavity cancer, oropharyngeal cancer, Kaposi sarcoma, Kaposi's sarcoma, adenoid cystic carcinoma, mucoepidermoid carcinoma, adenocarcinoma, anaplastic carcinoma, palate cancer, palate tumor

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Contributor Information and Disclosures

Author

Nader Sadeghi, MD, FRCS(C), Associate Professor of Surgery, Director of Head and Neck Surgery, Division of Otolaryngology, George Washington University
Nader Sadeghi, MD, FRCS(C) is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, Federation of Medical Specialists in Quebec, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Coauthor(s)

Khalid Al-Sebeih, MD, FRCSC, Fellow, Department of Otolaryngology, Kuwait University Faculty of Medicine
Khalid Al-Sebeih, MD, FRCSC is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, Canadian Academy of Facial Plastic and Reconstructive Surgery, Canadian Society of Otolaryngology-Head & Neck Surgery, Kuwait Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Medical Editor

M Abraham Kuriakose, MD, DDS, FRCS, Chairman, Head and Neck Institute, Amrita Institute of Medical Sciences
M Abraham Kuriakose, MD, DDS, FRCS is a member of the following medical societies: American Association for Cancer Research, American Head and Neck Society, British Association of Oral and Maxillofacial Surgeons, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Karen Hall Calhoun, MD, Professor, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University
Karen Hall Calhoun, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Medical Association, American Rhinologic Society, Association for Research in Otolaryngology, Society of University Otolaryngologists-Head and Neck Surgeons, Southern Medical Association, Texas Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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