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7 - Neck and distant disease spread

Published online by Cambridge University Press:  24 August 2009

By
Ann D. King
Edited by
Robert Hermans
Robert Hermans
Affiliation:
University Hospital Leuven, Belgium
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Summary

Nodal metastases

Background

Cervical nodal metastases have a significant impact on the outcome of patients with squamous cell cancer (SCC) of the head and neck (HNSCC). Nodal metastases are a cause of mortality in patients in whom the primary cancer is controlled, and they increase the risk of distant metastases. Prognosis decreases with increasing nodal stage and overall the rate of cure is halved in those patients with nodal spread. Classification of nodal groups was based originally on anatomical location according to Rouvière and later adapted to surgical levels. These surgical levels have since been translated to radiological levels using anatomical landmarks on axial computed tomography (CT) and are in the process of being adapted to clinical target volumes for image-guided radiotherapy. Both anatomical sites and levels are currently used in clinical practice (Fig. 7.1). Disease within the nodes tends to spread in an orderly fashion down the neck, although skip metastases are found in 5% of patients and routes of spread may be altered by bulky nodal disease and previous treatment. The sites of preferential nodal spread from primary HNSCC are shown inTable 7.1. Staging nodal metastases is performed using the TNM classification set out by the American Joint Committee on Cancer (Table 7.2). For nodal staging purposes, 3 and 6 cm are the important size criteria. Nodal metastases denote advanced stage disease (N1, stage III; N2, stage IV).

Type
Chapter
Information
Squamous Cell Cancer of the Neck , pp. 114 - 134
Publisher: Cambridge University Press
Print publication year: 2008

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