Noncervical lymph node metastasis from head and neck cancer

Abstract

Nonregional lymph node dissemination must be classified as distant metastasis but axillary and mediastinal metastases can be part of a regional dissemination of the disease. Metastases to lymph nodes of the upper mediastinum are very common among patients with subglottic, hypopharynx and thyroid carcinomas. Axillary metastases are found at autopsy in 2-9% of the patients who died of head and neck squamous cell carcinoma (SCC) and are frequently associated with skin implantation in aggressive recurrent head and neck carcinomas. The possible explanations for this location of metastasis were retrograde dissemination due to lymph system blockage, further tumor dissemination after a parastomal recurrence, hematogenous dissemination, and metastasis from a second primary tumor. Patients with distant metastasis have been considered incurable and only palliative treatment was instituted. Treatment planning for cases with axillary metastasis must take in consideration the likelihood of other regional recurrences and/or distant metastasis. Also, the presence of a second primary tumor must be ruled out. Whenever axilla is the only site of cancer recurrence, a standard axillary dissection must be considered. Upper mediastinal metastases from subglottic and hypopharyngeal cancer are managed by paratracheal and mediastinal dissection through the neck and postoperative radiotherapy.