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Metastatic Lymph Nodes

Determining Your Prognosis

Your prognosis is a prediction of the outcome of your disease. What is the risk of succumbing to the cancer or the risk of its coming back? These are the big questions on most people’s minds after receiving a diagnosis of head and neck cancer.

It is very difficult to discuss prognosis without understanding all the details of your cancer, and this is a conversation you’re better off having in person with your doctor. To give you a percentage chance of cure is really difficult because cancer research looks at all sorts of different types of cancers and may include patients from long ago.

Cancer that has spread to lymph nodes generally makes the disease an advanced stage cancer. Treatment typically involves different types. Cancer that has spread to lymph nodes definitely affects prognosis. There is even data to suggest that prognosis is worse with multiple involved lymph nodes, lymph nodes lower in the neck and spread of cancer cells outside the capsule of the lymph node. Still, if treated appropriately, cancer from the head and neck that has spread to lymph nodes can be cured.

See the article about your primary cancer type to learn more about prognosis of different cancers once they have spread to lymph nodes (regional disease).

For cancer with an unknown primary (CUP), an interesting systematic review article studied survival and found that overall estimated disease-specific survival at five years was 49 percent. (Estimated disease-specific survival is the percentage of people with a specific cancer who are alive at a given time point, such as five years after diagnosis. It excludes people who may have died from a disease other than their cancer. It is probably the best estimate we have in these large national databases as to the prognosis of a particular type of cancer at each stage.) Five-year survival based on N stage was as follows:

  • N1 61%
  • All N2 51%
  • N2a 64%
  • N2b 43%
  • N2c 38%
  • N3 26%

For CUP, doctors have much to study and learn, particularly as diagnostic procedures in the future will hopefully find more primary cancers. Also, as we learn more about HPV-related cancers in the head and neck, doctors hope to get better information on 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.

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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