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SU19.1-2,SU20.1-2,SU21.1-2 | Face, Mouth, Oropharynx and Salivary Glands — Assignment
CLINICAL SCENARIO
A 52-year-old man presents to the surgical outpatient clinic with a non-healing ulcer on the right lateral border of his tongue that he first noticed about two months ago. He has chewed a tobacco–areca nut (gutka) mixture several times a day for thirty years and smokes occasionally. On examination there is a 2 cm indurated ulcer with rolled edges, an adjacent white patch on the buccal mucosa, and a single firm, mobile lymph node in the right level II of the neck. He is otherwise well.
Instructions
Work through this patient as the managing surgical team would, from first contact to a treatment recommendation. Ground every step in the principles you studied for oral and oropharyngeal cancer: the three-week non-healing-ulcer rule, the role of premalignant lesions, triple assessment and staging, and stage-directed multidisciplinary treatment. Write in clear clinical prose; you are expected to justify each decision, not merely list facts.
Length: 900–1200 words
What to Submit
1. Clinical reasoning and red flags
Explain why this ulcer must be regarded as malignant until proven otherwise, identifying the specific high-risk features in the history and examination. Comment on the significance of the adjacent white patch and how erythroplakia would differ in implication.
Guidance: Use the three-week non-healing-ulcer rule; relate the patient's gutka/tobacco habit to aetiopathogenesis; distinguish leukoplakia from erythroplakia by malignant potential.
2. Investigations and triple assessment
Set out the investigations you would order to confirm the diagnosis and stage the disease, organising them under the principle of triple assessment, and state what each test contributes. Explain why panendoscopy is relevant.
Guidance: Cover clinical examination, imaging (to assess primary extent and the neck node), and tissue diagnosis (biopsy/histology). Note the purpose of panendoscopy in detecting synchronous second primaries.
3. Principles of treatment
Outline how treatment would be decided and the modalities available, applying the principle that management is stage-directed and multidisciplinary. Address the management of the primary tumour and the involved neck node, and the role of each treatment modality.
Guidance: Reference the tumour board, the three modalities (surgery, radiotherapy, chemotherapy) used singly or in combination, and the principle of addressing the at-risk/involved neck. Avoid quoting precise protocols; reason from principles.
4. Prevention and counselling
Describe the advice and preventive measures you would give this patient and what could be done at a population level, identifying the single most effective intervention.
Guidance: Tobacco and areca nut cessation is the cheapest, most effective intervention; include surveillance of premalignant lesions and public-health measures.
Grading Rubric — Oral Cancer Case — 20 points
| Criterion | Points | Full-marks descriptor |
|---|---|---|
| Clinical reasoning and identification of red flags | 5 pts | Correctly applies the three-week non-healing-ulcer rule, identifies all high-risk features, and accurately distinguishes leukoplakia from erythroplakia by malignant potential. |
| Investigations and application of triple assessment | 5 pts | Organises investigations under triple assessment, justifies each, and correctly explains the role of panendoscopy. |
| Principles of stage-directed, multidisciplinary treatment | 6 pts | Clearly explains stage-directed, tumour-board-led care, the three modalities, and management of both the primary and the neck. |
| Prevention, counselling and communication quality | 4 pts | Identifies tobacco/areca cessation as the key intervention, includes surveillance and public-health measures, and writes clearly and logically. |