A fit patient has a 12 mm lateral-tongue squamous carcinoma staged T1 N0 clinically, with no need for cervical access for reconstruction. Which neck strategy is recommended by NICE?
NICE recommends SLNB instead of elective neck dissection for T1–T2 N0 oral cavity cancer when cervical access is not otherwise required; the question tests management of an occult-risk neck, not palpation alone.
A. No neck treatment because imaging is negative: A clinically N0 neck can contain occult disease.
B. Radiotherapy to both necks for every T1 lesion: This is not the default strategy described by NICE.
C. Offer sentinel lymph-node biopsy rather than elective neck dissection: NICE recommends SLNB instead of elective neck dissection for T1–T2 N0 oral cavity cancer when cervical access is not otherwise required; the question tests management of an occult-risk neck, not palpation alone.
D. Immediate radical neck dissection: This is disproportionately morbid for a clinically N0 early lesion.
E. Wait for a nodal recurrence before acting: This abandons staging/treatment of known occult-risk disease.
If a free flap required cervical access, elective neck dissection may be the more appropriate surgical choice.
Draft Clinora educational material only; not official JCIE content, an accredited programme, or a substitute for local policy and specialist judgement.
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