An approach towards metastatic neck nodes and most common site of primaries: a retrospective study

Authors

  • Rudra Prakash Department of ENT and Head Neck Surgery, AIIMS, Patna, Bihar, India
  • Smrity Rupa Borah Dutta Department of ENT and Head Neck Surgery, SMCH, Silchar, Assam, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20193859

Keywords:

Metastatic neck nodes, Primaries, Management of N0 neck

Abstract

Background: Head and neck cancer is one of the most common cancers in India and worldwide. It accounts for 30 percent of the total cancer burden. Head and neck cancers are notorious for loco regional spread presenting late with metastastasis to cervical lymph nodes.

Methods: Our study was carried out on patients presenting with metastatic neck nodes at Silchar Medical College and Hospital, Assam from 1st April 2013 to 30th March 2015.  

Results: In our study 167 patients presented with head and neck cancer with metastatic neck nodes. Metastatic nodes involving level II accounted for 51.4% of cases with primaries in oral cavity, base of tongue. Level III lymph nodes were involved in 48.6% of cases with primaries in the hypopharynx and larynx.

Conclusions: In our study it was found that hypopharynx is the most common primary head and neck cancer with metastatic neck node. The most commonly involved lymph nodes are level II and level III. This helps in understanding the pattern of micrometastases in head and neck cancer patients with N0 neck which makes way for the role of selective neck dissection in these groups of patients.

References

Gregoire V, Lefebvre J-L, Licitra L, Felip E. On behalf of the EHNS-ESMO-ESTRO Guidelines Working Group. Squamous cell carcinoma of the head and neck:EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(Suppl. 5):v184–6.

D’Cruz A, Vaish R, Kapre N, Dandekar M, Gupta S, Hawaldar R, et al. Elective versus Therapeutic Neck Dissection in Node-Negative Oral Cancer. N Engl J Med. 2015;373(6):521-9.

Cancers, N. & Sites, A. Chapter 9 Head and Neck Cancers. 2011.

D'cruz A, Lin T, Anand AK, Atmakusuma D, Calaguas MJ, Chitapanarux I, et al. Consensus recommendations for management of head and neck cancer in Asian countries: A review of international guidelines. Oral Oncol. 2013;49(9):872–7.

Shah JP, Patel SG, Singh B. Jatin Shah’s Head and Neck Surgery and Oncology, 4th ed. Philadelphia: Elsevier; 2012: 426.

el Hag IA, Chiedozi LC, al Reyees FA, Kollur SM. Fine needle aspiration cytology of head and neck masses. Seven years’ experience in a secondary care hospital. Acta Cytol. 2003;47(3):387-92.

Ellison E, LaPuerta P, Martin SE. Supraclavicular masses: results of a series of 309 cases biopsied by fine needle aspiration. Head Neck. 1999;21(3):239-46.

Kumar V, Ramesh C, Reddy R. Leading sites of cancer in India. Consolidated report of the HBCR, 2007-2011. 2010;1:1–16.

Alvi A, Myers EN, Johnson JT. Cancer of the Oral Cavity. In: Myers EN, Suen JY, editors. Cancer of the head and neck. Philadelphia: W.B. Saunders Company; 1996: 321–361.

Mayne ST, Morse DE, Winn DM. Cancers of the oral cavity and pharynx. In: Schottenfeld D, Fraumeni FJ, editors. Cancer epidemiology and prevention. Oxford Univ Press; 2006.

Scottish Executive Health Department. Scottish Referral Guidelines for Suspected Cancer. Edinburgh: Scottish Executive Health Department; 2002. Available at: http://www.show.scot.nhs. uk/sehd/mels/hdl2002_45.pdf. Accessed on 3 June 2019.

Calabrese L, Jereczek-fossa BA, Jassem J. Diagnosis and management of neck metastases from an unknown primary. Acta Otorhinolaryngol Ital. 2005;5:2-12.

Ansari J, Glaholm J. Management of an unknown primary carcinoma. In: Watkinson John C. Stell & Maran’s Textbook of Head ND Neck Surgery and Oncology, 5th ed. Boca Raton: CRC Press; 2012: 690.

Paleri V, Watkinson John C. Metastatic neck disease. In: Watkinson John C. Stell & Maran’s Textbook of Head ND Neck Surgery and Oncology, 5th ed. Boca Raton: CRC Press; 2012: 663.

Chao CKS. Practical essentials of intensity modulated radiation therapy. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2005.

Paleri V, Watkinson John C. Metastatic neck disease. In: Watkinson John C. Stell & Maran’s Textbook of Head ND Neck Surgery and Oncology, 5th ed. Boca Raton: CRC Press; 2012: 669.

Shah JP, Patel SG, Singh B. Cervical Lymph Nodes. In: Thomas Stefanie J, editor. Jatin Shah’s Head and Neck Surgery and Oncology, 4th ed. Philadelphia: Elsevier; 2012: 430.

Cummings B, Kim J, O’Sullivan B. Radiation therapy and management of the cervical lymph nodes. In: Gaertner Schmidt R, editor. Cummings Otolaryngology Head and Neck Surgery, 4th ed. Philadelphia: Elsevier; 2005: 2592.

Paleri V, Watkinson John C. Metastatic neck disease. In: Watkinson John C. Stell & Maran’s Textbook of Head ND Neck Surgery and Oncology,5th ed. Boca Raton: CRC Press; 2012: 666.

Davidson BJ, Kulkarny V, Delacure MD, Shah JP. Posterior triangle metastases of squamous cell carcinoma of the upper aero digestive tract. Am J Surg. 1993;166(4):395-8.

Shah JP, Patel Snehal G, Singh B. Cervical Lymph Nodes. In: Thomas Stefanie J, editor. Jatin Shah’s Head and Neck Surgery and Oncology, 4th ed. Philadelphia: Elsevier; 2012: 432.

Paleri V, Watkinson John C. Metastatic neck disease. In: Watkinson John C.Stell & Maran’s Textbook of Head ND Neck Surgery and Oncology, 5th ed. Boca Raton: CRC Press; 2012: 667.

Royal College of Pathologists. Standards and Datasets for Reporting Cancers: Datasets for histopathology reports on head and neck carcinomas and salivary neoplasms. 2nd Edition. London: The Royal College of Pathologists; 2005. Available at: http://www.rcpath.org/resources/pdf/HeadNeck DatasetJun05.pdf. Accessed on 3 June 2019.

Robbins KT, Clayman G, Levine PA, Medina J, Sessions R, Shaha A, et al. Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. Arch Otolaryngol Head Neck Surg. 2002;128(7):751-8.

Downloads

Published

2019-08-27

Issue

Section

Original Research Articles