Noncervical lymph node metastasis from head and neck cancer

Nonregional lymph node dissemination must be classified as distant metastas is but axillary and mediastinal metastases can be part of a regional dissem ination of the disease. Metastases to lymph nodes of the upper mediastinum are very common among patients with subglottic, hypopharynx and thyroid car cinomas. Axillary metastases are found at autopsy in 2-9% of the patients w ho died of head and neck squamous cell carcinoma (SCC) and are frequently a ssociated with skin implantation in aggressive recurrent head and neck carc inomas. The possible explanations for this location of metastasis were retr ograde dissemination due to lymph system blockage, further tumor disseminat ion after a parastomal recurrence, hematogenous dissemination, and metastas is from a second primary tumor. Patients with distant metastasis have been considered incurable and only palliative treatment was instituted. Treatmen t planning for cases with axillary metastasis must take in consideration th e 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 hypopharyng eal cancer are managed by paratracheal and mediastinal dissection through t he neck and postoperative radiotherapy. Copyright (C) 2001 S.Karger AG, Bas el.