Imaging for Oropharyngeal Cancer

Imaging only required if it may change management

Distant pulmonary metastases / synchronous primary: CXR / CT chest

If radiation planned

  • Panorex to exclude dental disease or bone destruction
  • Imaging (CT/ MRI) to plan radiation

Imaging of Primary

  • T1: Rarely require imaging
  • T2: Consider CT scan prior to transoral resection to determine position of carotid artery
  • T3
    • Trismus: Rule out involvement of masticator space, PPS and ITF (CT scan)
    • If abuts mandible to decide about marginal / segmental / hemimandibulectomy (CT / Panorex)
  • Choice of imaging
    • Soft tissue: CT / MRI
    • Bone: Panorex / CT scan / MRI
    • Perineural spread: MRI

Cervical metastases

  • N0 neck: No need to image if elective neck dissection planned, unless concern about occult contralateral (base of tongue, soft palate) or retropharyngeal nodes
  • N+ neck: Image (U/S or CT) if concern about resectability

Index: Clinical Practice Guidelines for Oropharyngeal Cancer

Resource Appropriate Oropharyngeal Cancer Guideline Scenarios