Cancer of the oral cavity: management of the clinically negative neck

The management of the clinically uninvolved (No) neck in patients with cancers of the oral tongue, or floor of the mouth, including the gum, and treated by intra-oral resection remains contentious. The high incidence of metastasis to the neck found in patients selected for composite resection of tumours of these sites (30-59%) might suggest that elective treatment of the neck, either by neck dissection or irradiation, should be performed in all patients. To the contrary, it is shown that the incidence of late metastasis from T1 tumours, treated by intra-oral resection alone, is low (less than 20%), and although the incidence of late neck metastasis from T2 tumours which have been similarly treated, is 42.7%, death from uncontrolled disease in the neck, with the primary controlled, occurs in only 4%. Intra-oral resection of superficial T1 cancers without elective treatment of the neck appears justified, but the management of the No neck in patients with T2 tumours remains controversial.