Distant lymphatic metastasis from head and neck cancer

A predictable pattern of metastasis based on tumor histology and site of or igin has been well documented for most cancers that arise in the head and n eck region. The current study demonstrates that this predictable pattern of metastasis can be significantly impacted by previous therapy resulting in unusual patterns of metastasis in patients with recurrent tumors. A retrosp ective case series of 5 patients with head and neck carcinomas who develope d metastases to distant lymph nodes is presented. All patients underwent su rgery and radiotherapy to the primary tumor and regional lymphatics at the time of their initial treatment. All of the patients developed a local recu rrence less than a year before the detection of distant lymphatic metastase s. Cytology or excision confirmed metastases to the axillary, inguinal, or anterior intercostal lymph nodes. All of the patients underwent aggressive surgery for attempted cure of the local recurrence shortly before the prese nce of distant lymphatic metastases was clinically recognized. The metastat ic workup of patients with carcinomas of the head and neck frequently inclu des examination of the regional lymph nodes as well as chest radiography, l iver function tests, and serum calcium determination. This evaluation may f ail to detect metastases to distant lymph nodes in patients who present wit h recurrent or second primary cancers. Such patients should undergo careful examination of all major lymph node-bearing regions of the body when being evaluated for the presence of distant metastases.