STAGING & GRADING SYSTEM

Presented by:
Dr. Walia Tahseen Lazina
Intern Doctor
Mandy Dental College & Hospital
 CONTENT OF INTEREST
• Introduction.
• TNM Staging.
• Carcinoma in situ.
• Grading.
• Role of the Dental Practitioner in Cancer Prevention and
Diagnosis.
 INTRODUCTION
• Staging:
– It is the primary indicator of prognosis.
– Based upon size and extent of metastatic spread of the lesion.
• Grading:
– It reflects histologic subtype of tumour.
– Degree of differentiation exhibited by cells.
 TNM Staging
• T staging:
– Tx: Primary lesion cannot be assessed
– T0: No evidence of primary lesion
– Tis: Carcinoma in situ
– T1: Lesion 2 cm or less in the greatest diameter
– T2: Lesion >2 cm but <4 cm in the greatest diameter
– T3: Lesion >4 cm in the greatest diameter
– T4: T4 lesions have been divided into
– T4A: Lesion invades through cortical bone, into deep/extrinsic muscles of the
tongue, maxillary sinus or skin of face
– T4B: Lesion invades masticatory space, pterygoid plates, or skull base and/or
encases internal carotid artery.
 Carcinoma in situ
Carcinoma in situ is a type of non-invasive cancer. The tumour starts from the squamous cells on
the inner surface of the oral cavity and do not penetrate the basement membrane.
Buccal lesion

Lip lesion
Tongue lesion
 TNM Staging
• N staging:
– Nx: Regional LN cannot be assessed.
– N0:No regional LN metastasis
– N1: Metastasis to a single ipsilateral lymph node <3 cm in greatest
dimension
– N2A: Metastasis to a single ipsilateral node, >3 cm but not more than 6
cm in greatest dimension.
– N2B: Metastasis in multiple ipsilateral nodes none more than 6 cm in
greatest dimension.
– N2C: Metastasis in bilateral or contralateral nodes, none more than 6 cm
in greatest dimension.
– N3: Metastasis in a lymph node more than 6 cm in greatest dimension.
N Staging
 TNM Staging

• M staging:
– Mx: Distant metastasis cannot
be assessed.
– M0: No distant metastasis.
– M1: Distant metastasis present.

Sites of metastatic
spread.
TNM Staging
 GRADING
• Defines how closely cells resemble normal tissue
structure.
Gx Grade of differentiation cannot be
assessed.

G1 Well differentiated.

G2 Moderately differentiated.

G3 Poorly differentiated.

G4 Undifferentiated.
 Role of the Dental Practitioner in Cancer Prevention and Diagnosis

• Prevention:
– Actively discourage smoking and betel quid use
– Encourage moderation of alcohol intake.
– Health promotion and education on oral carcinoma.
– Provide check-ups for the edentulous and/or institutionalised elderly and
other high-risk non-attenders.
• Early diagnosis:
– Be vigilant and suspicious.
– Always examine all of the mucosa and the teeth.
– Monitor low-risk premalignant lesions.
– Refer all high-risk lesions on discovery.
– Perform biopsy appropriately.
 Role of the Dental Practitioner in Cancer Prevention and Diagnosis

• After treatment:
– Manage simple denture problems after surgery.
– Alleviate the effects of post-irradiation dry mouth, e.g. preventing caries.
– Monitor for recurrence, new premalignant lesions and second primary
tumours.
– Monitor for cervical metastasis.
– Maintain morale of and provide additional support to patients and their
relatives.
References :

• Oral and Maxillofacial Surgery

Neelima Anil Malik, 4th edition
• Cawson’s Essential of Oral Pathology and Oral Medicine E.W.Odell,
9th edition
• Wikipedia and Internet resources
THANK YOU FOR YOUR ATTENTION.