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Metastatic Lymph Nodes

Some patients with head and neck cancer first show up to a doctor’s office because they feel a “swollen gland” or lump in the neck. Lymph nodes can be enlarged for many reasons, including inflammation, infection or cancer. In general, swollen glands that get larger and then smaller, or those that go away, are not typically cancer. Also, enlarged lymph nodes that present for just one to two weeks are not typically cancer. Your doctor will have to put a number of pieces of your history and physical exam together to decide if additional tests are required.

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This article is about patients who have been diagnosed with metastatic lymph node(s) in the neck. The only way to make that diagnosis with certainty is after examination of some cells from the lymph node under a microscope.

Metastasis is the term used for spread of cancer cells outside of the primary tumor. Cancer spreads from the primary site in two ways: via lymphatics and via the bloodstream.

  • Lymphatic spread of cancer: Lymphatic spread of cancer is typical for most carcinomas. It occurs when tumor cells from the primary cancer site are transported to the lymph nodes through the lymphatic channels. This is often the first step in the spread of cancer, particularly for carcinomas. When invaded by tumor cells, the lymph nodes are usually enlarged. Read on to learn more about lymphatic spread of cancer.
  • Hematogenous spread of cancer: Another way cancers spread is through the blood (called hematogenous spread). This is more common for sarcomas and some carcinomas such as follicular thyroid carcinoma and some kidney cancers. Cancers that spread via the blood stream usually result in metastases to the lung or the liver.

Lymph nodes are tiny round or oval organs found all over your body, and they are connected through a complex system of lymphatic channels. They function to help the body fight infection via white blood cells. They act as filters of anything that should not be in the body, including cancer cells. Metastatic lymph nodes are those that have cancer cells within them (spread from a primary tumor somewhere else).

Lymphatic spread of cancer in the head and neck region results in enlarged lymph nodes in the face or neck (these are called regional lymph nodes because they are in the region of the head and neck).

For most (but not all) cancers of the head and neck, having cancer spread to the lymph nodes automatically puts your cancer into at least stage III. Positive lymph nodes decrease the probability of survival at five years by about 50 percent as compared with cancer that is limited to the primary site in early stage.

Also, spread of cancer cells outside the lymph node capsule, a higher number of lymph nodes with cancer and perhaps involved lymph nodes located lower in the neck might be associated with a worse prognosis and higher chance of spread to distant parts of the body. That said, doctors are still able to cure a significant number of patients with cancer that has spread to the neck with current treatment options.

Once a diagnosis of a metastatic cancerous lymph node in the neck has been made, the most important next step is to try to find a primary tumor if at all possible. If a primary site cannot be found after an exhaustive search (as discussed below), you will be given the diagnosis of cancer with an unknown primary (CUP).

References

1 Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. Patterns of cervical lymph node metastasis from squamous carcinomas of the upper aerodigestive tract. The American Journal of Surgery. 1990;160(4):405-409.

2 Patterns of Cervical Node Metastases From Squamous Carcinoma of the Larynx. Arch Otolaryngol Head Neck Surg. 1990;116(4):432-435.

3 Zhang MQ, El-Mofty SK, Dávila RM. Detection of human papillomavirus-related squamous cell carcinoma cytologically and by in situ hybridization in fine-needle aspiration biopsies of cervical metastasis: a tool for identifying the site of an occult head and neck primary. Cancer. 2008;114(2):118-23.

4 Morton DL, Wen DR, Foshag LJ, Essner R, Cochran A. Intraoperative lymphatic mapping and selective cervical lymphadenectomy for early-stage melanomas of the head and neck. J Clin Oncol. 1993;11:1751-1756.

5 Civantos FJ, Zitsch RP, Schuller DE, Agrawal A, Smith RB, Nason R, Petruzelli G, Gourin CG, Wong RJ, Ferris RL, El Naggar A, Ridge JA, Paniello RC, Owzar K, McCall L, Chepeha DB, Yarbrough WG, Myers JN. Sentinel lymph node biopsy accurately stages the regional lymph nodes for T1-T2 oral squamous cell carcinomas: results of a prospective multi-institutional trial. J Clin Oncol. 2010;28(8):1395-400.

6 Balaker AE, Abemayor E, Elashoff D, St. John MA. Cancer of unknown primary: does treatment modality make a difference? Laryngoscope.2012;122(6):1279-82. doi: 10.1002/lary.22424. Epub 2012 Apr 26.

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