Imaging studies have an important role in defining the extent of oropharyngeal neoplasms and coming to an accurate staging of these lesions. Besides influencing treatment choice, imaging studies can also be used to monitor tumour response to treatment, and as an adjunct to clinical follow-up in order to detect treatment failure as early as possible.

Keywords: Squamous cell cancer, head and neck, pharynx

Head and neck cancer commonly originates from the oropharynx. As in most head and neck sites, squamous cell cancer is the most frequently encountered malignant disease. Cigarette smoking and excessive alcohol consumption are well-known risk factors. The accuracy of pre-therapeutic staging is an important factor in the treatment planning of oropharyngeal neoplasms. High-quality imaging is of considerable help to the clinician examining patients with oropharyngeal cancer, by revealing submucosal tumour spread and detecting subclinical adenopathies.

Tongue base cancer

Cancer in the tongue base tends to grow silently and deeply, and is often larger than suspected at clinical examination. Tumours may spread, along the palatoglossal muscle, cornering the glossotonsillar sulcus, to involve the anterior tonsillar pillar.

Anterior spread into the floor of the mouth and/or tongue body may occur, along the mylo- and/or hyoglossal muscle, and/or along the lingual neurovascular bundle (Fig. 2). Tongue base cancer may also grow in a retrograde fashion along the lingual vessels towards the external carotid artery [1]. Vascular and perineural tumour spread is associated with reduced local and regional tumour control and reduced patient survival. A tumour mass with a overall diameter of more than 2 cm on imaging predicts vascular and perineural tumour spread [2]. Infiltration of the normal fatty tissue planes in the base of the tongue, of the fat in the sublingual space, as well as irregular tumour margins are also associated with an increased risk of vascular and perineural tumour spread. Such findings are related to overall tumour bulk.