Patterns of cervical metastasis from carcinoma of the oral tongue

BACKGROUND: Cancer of the oral tongue is the second most common cancer among males in various parts of India. Despite advances in diagnosis and treatment the failure rates in cancer of the oral tongue are high and survival poor. Majority of these failures occur in untreated neck. METHOD: A retrospective review of the records of 75 patients undergoing surgery for the treatment of squamous cell carcinoma of the oral tongue was carried out to ascertain the pattern of metastasis in the neck and to evaluate the sensitivity of clinical examination in predicting nodal spread. RESULTS: All the patients underwent primary surgery. Cervical lymph node metastasis was found in 35.6% of T1 and T2 tumours and 62.35% of T3 and T4 tumours. Sensitivity of clinical examination was found to be 54.5% and specificity of 61.9%. Level II was the most commonly involved (63.6%). Isolated level IV involvement was never found in clinically negative neck. Tumour stage and node status were found to have a significant impact on disease free survival in both univariate and multivariate analysis. CONCLUSIONS: As the sensitivity and specificity of the clinical examination is low we suggest that methods like ultrasound or CT Scan of the neck should be regularly employed to improve the sensitivity and specificity of the examination. Furthermore as isolated level IV involvement is never found in our series, we suggest that a prophylactic supraomohyoid neck dissection should be carried out in all patients with a clinically node negative neck with cancer of oral tongue, to achieve a better disease free survival.