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‘Close’ surgical margin in oral tongue redefined, 2.3mm is as good as 5mm
Gold standard treatment of squamous cell carcinoma (SCC) of the oral tongue remains surgical resection of the primary tumour with negative margins. The primary goal is the complete excision of the tumour with no residual cancer cells left behind. A...
An algorithm to distinguish between distant metastases and metachronous lung primary in patients with HPV-related oropharyngeal cancer
Distinguishing between distant metastases of HPV-related oropharyngeal squamous cell carcinoma (OPSCC) and metachronous primary lung squamous cell carcinoma (SCC) is important as it has implications for treatment, prognosis counselling, and registry data. Although p16 immunohistochemistry (p16 IHC) is widely accepted...
What should be considered a ‘close’ margin in oral cavity squamous cell carcinoma?
Achieving clear margins during surgical resection in oral cavity squamous cell carcinoma (OCSCC) is thought to reduce local recurrence (LR) and improve prognosis; however, what constitutes a clear, close, or involved margin is inconsistent in the literature and in practice....
Best timing for post-treatment PET-CT scans in head and neck cancer
Unfortunately we know that the recurrence rate for head and neck cancer can be high, up to 30-50% in some series. These recurrences tend to occur within the first two years following treatment. Optimal surveillance strategies to detect recurrences early...
Carotid artery involvement with head and neck metastases
This is a retrospective review of 27 patients radiologically diagnosed as having metastases involving the common or internal carotid arteries. All patients underwent a salvage neck dissection with surgical carotid peeling. Thirteen of the 27 achieved loco-regional control, five developed...
Synchronous bilateral tonsil cancer
There is a long-standing debate regarding either unilateral or bilateral tonsillectomy for histological confirmation of tonsil cancer. Bilateral tonsillectomy is the standard of care in Denmark for proven or suspected tonsil carcinoma, and in the diagnostic work-up of the unknown...
Useful algorithm to manage adults with branchial cysts
Managing a solitary cystic lateral neck mass, specifically differentiating between a simple second branchial cyst and a metastatic cyst poses a challenge. Often the diagnosis only becomes apparent on the final histology. This paper analysed 28 adults that presented to...
Extent of central neck dissection in the patients with thyroid carcinoma
The first level of lymphatic spread in well-differentiated thyroid carcinoma is to the central compartment of the neck, namely, the paratracheal, prelaryngeal and pretracheal lymph nodes. Central neck dissection may carry an increased morbidity, namely, hypoparathyroidism and recurrent laryngeal nerve...
Laryngeal cleft in a 66-year-old man!
This is a fascinating case report of a 66-year-old man who presented with a carcinoma of the piriform sinus. During chemoradiotherapy, he developed dyspnoea, dysphagia and aspiration pneumonia. His chemoradiotherapy was stopped and he underwent a pharygnolaryngectomy. When the surgical...
Delays in oral cancer
This is a review from Canada where they attempt to relate delays in oral cancer presentation to treatment and the impact on stage, diagnosis and survival. They recognise that potentially the most significant delay is between the patient first noticing...
What is the right balance to strike in the management of anaplastic thyroid cancer?
This is a pragmatic article on a difficult and much debated subject. Management of anaplastic thyroid cancer (ATC) can feel like making decisions between a rock and a hard place, and this article suggests one path to help navigate some...
