A 54-year-old male with a carcinoma of the retromolar trigone is being assessed for resectability. Contrast CT shows the tumor extending into the infratemporal fossa with encasement of 270 degrees of the external carotid artery and destruction of the skull base at the foramen ovale. According to AJCC 8th edition staging, this tumor is best classified as:
- A T4b, very advanced local disease, generally considered unresectable ✓
- B T4a, moderately advanced local disease, resectable with composite resection
- C T3, moderately advanced disease
- D T2 with adverse features
Correct answer: A. T4b, very advanced local disease, generally considered unresectable
Explanation
Oral cavity T4b includes masticator space extension, pterygoid plate involvement, skull base invasion, and encasement of the carotid artery, all features of very advanced, usually unresectable disease. T4a denotes resectable moderate advancement such as cortical bone invasion, deep tongue muscle, or skin involvement. Skull base destruction and carotid encasement clearly place this lesion beyond T4a.
Reference: AJCC Cancer Staging Manual, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.