History & Examination for Oral Cancer


  • Select appropriate surgery
  • Avoid unnecessary surgery
  • Avoid embarking on surgery that is beyond the scope of a surgeon

Primary tumour

  • Site
  • Diameter
  • Depth of invasion (palpation)
    • >4mm, then treat the neck electively
    • 5-10mm: T2
    • >10mm: T3
  • Soft tissue invasion
  • Tongue mobility
  • Trismus
  • XIIn, Lingual nerve, mental nerve dysfunction
  • Mandible
    • If adherent, then assess mandible invasion
    • Dental caries if to receive radiation therapy

Cervical nodes

  • Palpate the neck
  • Palpate Level 1b between a finger placed on the floor of mouth and another on the neck
    • To detect nodes
    • To distinguish between SMG and lymph node as nodes are lateral/superficial to SMG are generally palpable only with the finger on the neck, as opposed to a SMG mass that is palpable between both fingers
  • Palpable nodes in lymphatic basin: assume metastases
  • No palpable nodes
    • T1 <4mm depth: Watchful waiting
    • T1 >4mm depth, T2-4: Electively treat neck
  • Nodes outside lymphatic basin e.g. lateral cancer with contralateral nodes, then consider FNAC / nodal biopsy

Synchronous Primary (upper aerodigestive tract, lungs)

  • History and office examination
  • Panendocopy
  • CXR / CT / PET

Index: Clinical Practice Guidelines for Oral Cancer

Resource Appropriate Oral Cancer Guideline Scenarios