Clinical assessment of cervical node in head and neck malignancy: case series

Leena Rajam K., Vikram V. J., Anjan Kumar Selvaraj, Saravana Babu P.


Background: Lymph node involvement is well established as an important prognostic factor for head and neck cancer, the spread of carcinoma of head and malignancy to the node levels is probably predictable according to the site of the primary. The appropriate staging of cervical lymph nodes is very important in the management of any head and neck primary carcinoma. Clinical palpation of cervical lymph nodes may yield false negative and false positive results.

Methods: In a prospective study in patients of patients with primary malignancy from larynx, any sub site of pharynx (nasopharynx/oropharynx/hypopharynx) of histologically proven squamous cell carcinoma, the nodal status of primary tumour, the level of lymph node involved and the stage of presentation of the tumor and node were analysed clinically.

Results: 61 cases included in our study, where males were 52 cases and females were 9 cases. The age incidence ranging from 35 years to 76 years noted. In the distribution of nodal secondary carcinoma of the nasopharynx was 100% nodal positive followed by hypopharynx, oropharynx, and larynx. 21% of patient presented in the N0 stage. The remaining 79% were node positive. In nodal secondary by size of primary most of the patients presented with T3 disease (52%) followed by T2 disease (26%), T1 disease (11%) and T4 disease (11%).

Conclusions: In malignancy of larynx, pharynx, lymph node assessment clinically is an important prognostic factor to determine the staging of tumour. The clinical evaluation may also have false negative, so radiological evaluation will further give a detailed assessment of the nodes for better treatment outcomes to reduce the overall mortality.



Clinical assessment, Neck node, Primary tumor, Head and neck

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Greene F, Trotti A III, Fritz A, Compton C, Byrd DR, Edge S. AJCC Cancer Staging Handbook. 7th ed. Chicago, IL: American Joint Committee on Cancer; 2010.

Cerezo L, Millan I, Torre A, Aragon G, Otero J. Prognostic factors for survival and tumor control in cervical lymph node metastases from head and neck cancer: a multivariate study of 492 cases. Cancer. 1992;69:1224-34

Haksever M, Inançlı HM, Tunçel U, Kürkçüoğlu SS, Uyar M, Genç O, et al. The effects of tumor size, degree of differentiation, and depth of invasion on the risk of neck node metastasis in squamous cell carcinoma of the oral cavity. Ear Nose Throat J. 2012;91:130–5.

Shah JP, Candela FC, Poddar AK. The patterns of cervical lymph node metastases from squamous carcinoma of the oral cavity. Cancer. 1990;66:109–13.

Patel SG, Shah JP. TNM staging of cancers of the head and neck: striving for uniformity among diversity. CA Cancer J Clin. 2005;55:242–58.

Ferlito A, Robbins KT, Shah JP, Medina JE, Silver CE, et al. Proposal for a rational classification of neck dissections. Head Neck. 2011;33:445-50.

Sureshkannan P, Vijayprabhu, John R. Role of ultrasound in detection of metastatic neck nodes in patients with oral cancer. Indian J Dent Res. 2011;22:419-23.

Anand N, Chaudhary N, Mittal MK, Prasad R. Comparison of the efficacy of clinical examination, ultrasound neck and computed tomography in detection and staging of cervical lymph node metastasis in head and neck cancers. Indian J Otolaryngol Head Neck Surg. 2007;59:19-23.

Castelijns JA, van den Brekel MW. Detection of lymph node metastases in the neck: radiologic criteria. Am J Neuroradiol. 2001;22:3-4.

Yuasa K, Kawazu T, Kunitake N, Uehara S, Omagari J, Yoshiura K, et al. Sonography for the detection of cervical lymph node metastases among patients with tongue cancer: criteria for early detection and assessment of follow-up examination intervals. AJNR Am J Neuroradiol. 2000;21:1127-32.

Hoang JK, Vanka J, Ludwig BJ, Glastonbury CM. Evaluation of cervical lymph nodes in head and neck cancer with CT and MRI: tips, traps, and a systematic approach. AJR Am J Roentgenol. 2013;200:17-25.

Shear M, Hawkins DM, Farr HW. The prediction of Lymph node metastasis from oral squamous carcinoma. Cancer. 1996;37:1901-7.

Chen CC, Lin JC, Chen KW. Lymph node ratio as a prognostic factor in head and neck cancer patients. Radiation Oncol. 2015;10:181.

Saafan ME, Elguindy AS, Abdel–Aziz MF, Abdel-Rahman Younes A, Albirmawy OA, et al. Assessment of Cervical Lymph Nodes in Squamous Cell Carcinoma of the Head and Neck. Surgery Curr Res. 2013;3:145.

Lindberg R. Distribution of Cervical Lymph Node Metastases from squamous cell carcinoma of the Upper respiratory and digestive tracts. Cancer. 1972;29:1446.