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Metastatic Lymph Nodes

Understanding the Anatomy

Fluid around cells—along with toxins, bacteria, viruses, nutrients and proteins—enters lymphatic vessels near arterioles and veins. This fluid, once inside the lymphatic vessel, is called lymph. Lymph contains byproducts from cells in organs and tissues all over the body. Lymph travels from these tissues throughout the body via lymphatic channels. Lymph then enters into the blood stream through connections with veins as well as in the spleen. The organs of the lymphatic system are lymph nodes, the spleen and the thymus. In addition, the (palatine) tonsils, adenoids and lingual tonsils are part of the lymphatic system.

Lymph and lymph nodes are found all over the body, in and around all organs. That is why the blood cancer called lymphoma can present just about anywhere in the body. When a head and neck cancer spreads into the lymph system, however, there is a fairly predictable pattern of where the cancer spreads.

Head and neck cancers spread to regional lymph nodes in the neck. The regional lymph nodes of the head are broken down into different regions. This helps doctors talk about and research spread of cancer into the neck:

73_lymph_nodes_neck07_neck_levels

Interestingly, there is actually a pattern to which level certain cancers spread when they enter the lymphatic system:

Lymph Node Group with Metastatic Cancer Site of Primary Tumor
Pre-auricular (in front of the ear) and parotid nodes Front half of scalp and the skin of the upper part of the face
Post-auricular (behind the ear) and suboccipital (the nape of the neck) Back half of the scalp and the back part of the ear
Retropharynx (behind the throat, sitting in front of the spine) The thyroid gland, nasopharynx and esophagus
Level I, II, III Oral cavity
Level II, III, IV Oropharynx, hypopharynx, larynx
Level V Scalp, facial skin
Level VI Thyroid, larynx, hypopharynx, esophagus
Level VII Thyroid

 

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.

7 Cooper, J. S., et al. (2004). "Postoperative Concurrent Radiotherapy and Chemotherapy for High-Risk Squamous-Cell Carcinoma of the Head and Neck." New England Journal of Medicine 350(19): 1937-1944.

8 Bernier, J., et al. (2004). "Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer." N Engl J Med 350(19): 1945-1952.

9 Doescher, J., et al. (2017). "[The 8th edition of the AJCC Cancer Staging Manual: Updates in otorhinolaryngology, head and neck surgery]." HNO 65(12): 956-961.

10 Cohen, E. E., LaMonte, S. J., Erb, N. L., Beckman, K. L., Sadeghi, N. , Hutcheson, K. A., Stubblefield, M. D., Abbott, D. M., Fisher, P. S., Stein, K. D., Lyman, G. H. and Pratt‐Chapman, M. L. (2016), American Cancer Society Head and Neck Cancer Survivorship Care Guideline. CA: A Cancer Journal for Clinicians, 66: 203-239. doi:10.3322/caac.21343 

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