Two weeks ago I received the definitive histopathologic report of one of my patients who underwent radical surgery for oral cancer. In anticipation of surgery some investigations were carried out showing evidence of mandible invasion, a fact which was already clinically suspected. Therefore, mandible resection was primarily planned and performed along with tumor excision and related neck dissection.

As I read the pathologic findings I wondered if something had completely gone wrong “…following decalcification, wide bone invasion is now evident in cortical bone of the mandible as well as bone marrow…the definitive classification assessed was pT2…”.

Since this result not only reflects some confusion but may also represent over-treatment and affect the kind of adjuvant therapy and consequently the prognosis of the patients, we contacted the consultant pathologist.

After we had asked her about the reference of this classification – none other than the German version of UICC – we reviewed the two versions, the English and German one.

As mentioned by P atel & S hah based on the publication of the Joint Committee on Cancer (AJCC) :

T4a Oral cavity: Tumor invades through cortical bone, into deep [extrinsic] muscle of the tongue, …, etc.

The German version neglects the enumeration in this recital; hence the same source of this statement is translated as follows:

T4a Mundhöhle: Tumor infiltriert durch kortikalen Knochen in äußere Muskulatur der Zunge, ….

Which would mean: T4a Oral cavity: Tumor invades across the cortical bone into the deep [extrinsic] muscle of the tongue , …, etc.

The additional English notification regarding site-specific changes in description of T4a and T4b categories explicitly outlines the particular character of each description and does not allow any misinterpretation :

T4a Oral cavity: Tumor invades adjacent structures (e.g., through cortical bone, into deep [extrinsic] muscle of the tongue, maxillary sinus, …, etc.)

Apparently, punctuation was at the core of this issue: The missing “COMMA” in the translated version obviously caused considerable confusion in the comprehension and interpretation as well as therapeutic consequences of oral cancer in German-speaking countries.

As a new edition of AJCC Cancer Staging Manual may appear in the near future, we hope that the reader of IJOMS may pay more attention to this semantic problem and motivate publishers to deepen their interest in translation services in order to prevent misunderstanding, not only in regard to the German language but also to probably much more delicate non-European languages.