Cervical lymph node metastases of head and neck cancer.

One of the most important criteria of malignancy of head and neck cancer ar e the cervical lymph metastases. Being significant for the therapeutical pl an is how tumor depending parameters like T-stage, degree of differentiatio n and tumor localisation will influence the N-stage and therefore the exten sion of neck dissection. Method: To evaluate the pattern of formations of m etastases and the success of therapy a retrospective study was performed on 405 patients with carcinoma of the oral cavity (n=47), the oropharynx (n=1 17), the hypopharynx (n=47) and the larynx (n=193). Results: By the time of surgery carcinoma of the hypopharynx were most frequently accompanied by c ervical metastases (80 %), followed by carcinoma of the oropharynx (70%), t he oral cavity (52 %) and the larynx (26%). Occurrence and extension of reg ional lymph node metastases correlated well with T-stages and degree of dif ferentiation. After surgical therapy locoregional recurrence could be obser ved in 5.2% of the patients. Five-year-survival rate was reduced to 50% on patients with positive lymph nodes. The different tumour sites showed prefe rred patterns of metastatic spread, without complete avoidance of certain l evels. Conclusion: For the decision on indication and extent of neck dissec tion the preoperative diagnostic (ultrasound, CT-scan, MRI), localisation o f tumour, T-stage, degree of differentiation and the knowledge of typical m etastatic spread must be considered.