Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Management of the N3 Neck Workup

  • Author: Niels Kokot, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Feb 06, 2014
 

Laboratory Studies

Laboratory studies should include the following:

  • Basic metabolic panel
  • CBC count
  • Liver function tests
  • Prealbumin and albumin
  • Coagulation panel
  • Blood type and cross-match
  • P16 testing on biopsy specimen of oropharyngeal primary (surrogate test for human papillomavirus)

Liver function tests, as a part of the metabolic panel, may be used to identify liver metastasis. However, they are nonspecific and are not sensitive. Elevated results of liver function tests may reflect associated alcoholic liver disorders. Electrolyte abnormalities may reflect tumor-induced syndrome of inappropriate antidiuretic hormone (SIADH).

Next

Imaging Studies

Evaluation of N3 neck disease is as follows:

  • CT scan with contrast is useful in determining resectability and the extent of the primary tumor and nodal disease.
  • MRI with gadolinium can demonstrate soft tissue changes and reveal perineural spread.
  • Positron emission tomography (PET)–CT fusion study may be helpful in patients who present with N3 nodes with an unknown primary tumor. PET-CT scans were able to reveal an unknown primary tumor in 57% of cases compared with CT scan alone, which identified the unknown primary tumor in 23% of cases. Despite the increased ability of PET-CT scanning to reveal unknown primary sites, 43% of the primary sites were not identified. [10]

Evaluation for lung metastasis and second lung primary is as follows:

  • Patients with N3 neck disease are at increased risk for developing distant metastasis. Garavello et al (2006) found patients with N3 disease developed distant metastases 29.55% of the time and had a 10.7 times increased risk of developing distant metastases.
  • The lung is the most common site of distant metastasis in head and neck cancer, as supported by both clinical and autopsy studies.
  • Chest radiography has poor sensitivity in detecting lung metastasis (sensitivity of 50%, specificity is 94%. [11] )
  • The incidence of pulmonary malignancy in head and neck cancer is 4.5-14%. Secondary lung malignancy is a high risk if the primary tumor originated from the larynx or pharynx.
  • The lifetime risk in developing secondary malignancy in patients with head and neck cancer can be as high as 20%.
  • CT scan is the single most sensitive imaging study used to reveal lung metastasis and, therefore, should be the modality of choice, at least in high-risk patients (stage 4 disease, T4 tumor, N2 or N3 nodal disease, tumors that arise from the oropharynx, larynx, hypopharynx, or supraglottis). [12]
  • Yearly chest radiography is suggested to evaluate for second primary lung tumors or distant metastasis.
Previous
Next

Other Tests

See the list below:

  • Evaluation for liver metastasis
    • Liver metastasis usually presents in association with other metastases, especially lung metastasis. Liver metastasis alone is rare. Screening tests used to identify liver metastasis are nonspecific and are not sensitive. Elevated results of liver function tests may reflect associated alcoholic liver disorders.
    • Although ultrasonography, CT scanning, and MRI are sensitive imaging modalities for liver metastasis, if the index of suspicion is high, especially in the presence of lung metastasis, a liver ultrasound or CT scan can be performed to confirm clinical suspicion.[13]
  • Evaluation for bone metastasis
    • Bone metastasis is invariably associated with lung metastasis; 50% of cases of bone metastasis involve multiple bony sites. The spine is the most common site of metastasis (12.7%), followed by the skull (4.2%), the rib (3.1%), and axial bone (femur, humerus [2.1%]).[7]
    • Alkaline phosphatase is sensitive for osteoblastic bone metastasis. It is not sensitive for revealing bone metastasis in head and neck squamous cell cancer head because this type of bone metastasis is osteolytic.
    • Bone scan is sensitive in the diagnosis of bone metastasis; however, it is useful only if the patient is clinically symptomatic. Routine bone scan is not necessary.
  • Carotid artery evaluation
    • MR studies have shown that, if the carotid artery is surrounded by tumor in 270° or less, no carotid artery invasion has occurred.[14] Yoo et al compared preoperative CT findings with histologic findings in patients who underwent carotid artery resection.[15] If the carotid artery was encircled more than 180° by the tumor on CT scan, then the tumor invaded the elastic lamina of the carotid artery and patients had poorer outcomes.
    • In patients who have undergone chemotherapy or radiation treatment, surgical planes between the carotid artery and the tumor are obscured. In these cases, CT scanning or MRI are less accurate in predicting carotid artery invasion.[14]
    • Planned carotid artery resection or embolization requires preoperative testing to assure adequate collateral blood flow through the contralateral carotid artery and/or vertebral artery system. In addition, the presence or absence of carotid stenosis must be assessed.

Discussing the different indications and contraindications, complications, and advantages of each test is beyond the scope of this chapter. Invasive tests used to evaluate collaterals of the carotid artery can cause neurologic complications post-procedure. Several studies have conclusively shown that severe hemodynamic impairment is a strong predictor of stroke in patients who undergo carotid artery occlusion. In the St Louis Carotid Occlusion Study, a prospective study that evaluated cerebral hemodynamic and stroke risk, more than half of the symptomatic and asymptomatic patients had a normal oxygen extraction fraction.[16]

Previous
Next

Diagnostic Procedures

See the list below:

  • Biopsy is necessary to confirm the diagnosis. Fine-needle aspiration biopsy (FNAB) of the neck mass is the only required test for the diagnosis. If readily available, a biopsy procedure can be performed on the primary tumor. The use of core biopsy has also been reported. [17]
  • The use of an open biopsy procedure is necessary only if the diagnosis cannot be attained with FNAB and a lymphoma is suspected.
  • Patients with head and neck carcinoma are at risk for synchronous primary tumors. Panendoscopy, including direct laryngoscopy, bronchoscopy, and esophagoscopy, has classically been performed to assess the both the primary tumor and to identify the presence of synchronous primary tumors.
Previous
Next

Histologic Findings

As mentioned above, squamous cell carcinoma is the most common cause of carcinoma of the aerodigestive tract with cervical metastasis. For patients who undergo surgical treatment of their disease, the histologic features of the primary tumor and neck dissection are important for determining the need for adjuvant therapy.

At the primary site, the surgeon and pathologist alike are interested in the size of the tumor, the presence of positive surgical margins, perineural or lymphovascular invasion, and invasion of surrounding structures. In addition, the pathologist will comment on the grade of differentiation of the tumor, ranging from well differentiated, to moderately differentiated, and poorly differentiated.

However, in squamous cell carcinoma, the grade of the tumor in general does not impact prognosis. On the other hand, the grade of the tumor is important in salivary gland carcinomas. In the neck, features of interest include the size of the tumor, the number and location of involved nodes, and the presence of extracapsular extension of the tumor outside the lymph node.

High-risk features that have long been considered indications for postoperative radiotherapy include advanced T stage, perineural invasion, and multiple positive lymph nodes.

Patients who benefit from the addition of chemotherapy to postoperative radiotherapy are those with positive margins and those with extracapsular spread.[18, 9]

Previous
Next

Staging

The reader is referred to the current AJCC (6th edition) and UICC guidelines for T staging of the primary tumor at the individual head and neck sites.

AJCC and UICC nodal categories (except thyroid and nasopharyngeal carcinoma) are as follows:

  • Nx - Regional lymph nodes that cannot be assessed
  • N0 - No regional node metastasis
  • N1 - Metastasis in a single ipsilateral lymph node, 3 cm or smaller
  • N2a - Metastasis in a single ipsilateral lymph node larger than 3 cm but not larger than 6 cm
  • N2b - Metastasis in multiple ipsilateral lymph nodes, none larger than 6 cm
  • N2c - Metastasis in bilateral or contralateral lymph nodes, none larger than 6 cm
  • N3 - Metastasis in a lymph node larger than 6 cm

Distant metastasis categories are as follows:

  • Mx - Distant metastasis cannot be assessed
  • M0 - No distant metastasis
  • M1 - Distant metastasis

The combination of the primary tumor, nodal status, and presence or absence of distant metastasis is used as a part of the overall staging of the patient’s disease according to AJCC and UICC guidelines, as follows:

Table 1. Staging (Open Table in a new window)

Stage Tumor Node Metastasis
Stage I T1 N0 M0
Stage II T2 N0 M0
Stage III T3 N0 M0
  T1 N1 M0
  T2 N1 M0
  T3 N1 M0
Stage IVa T4a N0 M0
  T1 N1 M0
  T2 N2 M0
  T3 N2 M0
  T4a N2 M0
Stage IVb Any T N3 M0
  T4a Any N M0
Stage IVc Any T Any N M1
Previous
 
 
Contributor Information and Disclosures
Author

Niels Kokot, MD Assistant Professor, Residency Program Director, Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California

Niels Kokot, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Gregory S Weinstein, MD, FACS Professor and Vice-Chairman, Department of Otorhinolaryngology-Head and Neck Surgery, Director of Division of Head and Neck Surgery, Director of Head and Oncology Fellowship, Director of Otorhinolaryngology-Head and Neck Clinic, Co-director of The Center for Head and Neck Surgery, University of Pennsylvania School of Medicine

Gregory S Weinstein, MD, FACS is a member of the following medical societies: American Head and Neck Society, American Laryngological Association, American Radium Society, Pennsylvania Medical Society, Philadelphia County Medical Society, Society of University Otolaryngologists-Head and Neck Surgeons, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, The Triological Society, American Medical Association

Disclosure: Nothing to disclose.

Mark Swanson, MD Resident Physician, Department of Otolaryngology, Los Angeles County and USC Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Karen H Calhoun, MD, FACS, FAAOA Professor, Department of Otolaryngology-Head and Neck Surgery, Ohio State University College of Medicine

Karen H Calhoun, MD, FACS, FAAOA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Head and Neck Society, Association for Research in Otolaryngology, Southern Medical Association, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Rhinologic Society, Society of University Otolaryngologists-Head and Neck Surgeons, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

William M Lydiatt, MD Professor and Division Director, Head and Neck Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center

William M Lydiatt, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, Nebraska Medical Association

Disclosure: Nothing to disclose.

References
  1. Spiro RH, Alfonso AE, Farr HW, Strong EW. Cervical node metastasis from epidermoid carcinoma of the oral cavity and oropharynx. A critical assessment of current staging. Am J Surg. 1974 Oct. 128(4):562-7. [Medline].

  2. Liu XK, Li Q, Zhang Q, Su Y, Shi YX, Li H, et al. Planned Neck Dissection before Combined Chemoradiation in Organ Preservation Protocol for N2-N3 of Supraglottic or Hypopharyngeal Carcinoma. ORL J Otorhinolaryngol Relat Spec. 2012 Feb 9. 74(2):64-69. [Medline].

  3. Igidbashian L, Fortin B, Guertin L, Soulières D, Coulombe G, Belair M, et al. Outcome with neck dissection after chemoradiation for N3 head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2010 Jun 1. 77(2):414-20. [Medline].

  4. Bocca E, Pignataro O. A conservative technique in radical neck dissection. Ann Otol Rhinol Laryngol. 1967. 76(5):975-87.

  5. Garavello W, Ciardo A, Spreafico R, Gaini RM. Risk factors for distant metastases in head and neck squamous cell carcinoma. Arch Otolaryngol Head Neck Surg. 2006 Jul. 132(7):762-6. [Medline].

  6. Buck G, Huguenin P, Stoeckli SJ. Efficacy of neck treatment in patients with head and neck squamous cell carcinoma. Head Neck. 2008 Jan. 30(1):50-7. [Medline].

  7. Ferlito A, Shaha AR, Silver CE, Rinaldo A, Mondin V. Incidence and sites of distant metastases from head and neck cancer. ORL J Otorhinolaryngol Relat Spec. 2001 Jul-Aug. 63(4):202-7. [Medline].

  8. Ferlito A, Silver CE, Shaha AR, Rinaldo A. Management of N3 neck. Acta Otolaryngol. 2002 Mar. 122(2):230-3. [Medline].

  9. Bernier J, Cooper JS, Pajak TF, et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck. 2005 Oct. 27(10):843-50. [Medline].

  10. Freudenberg LS, Fischer M, Antoch G, et al. Dual modality of 18F-fluorodeoxyglucose-positron emission tomography/computed tomography in patients with cervical carcinoma of unknown primary. Med Princ Pract. 2005 May-Jun. 14(3):155-60. [Medline].

  11. Troell RJ, Terris DJ. Detection of metastases from head and neck cancers. Laryngoscope. 1995 Mar. 105(3 Pt 1):247-50. [Medline].

  12. Loh KS, Brown DH, Baker JT, Gilbert RW, Gullane PJ, Irish JC. A rational approach to pulmonary screening in newly diagnosed head and neck cancer. Head Neck. 2005 Nov. 27(11):990-4. [Medline].

  13. Keski-Santti HT, Markkola AT, Makitie AA, Back LJ, Atula TS. CT of the chest and abdomen in patients with newly diagnosed head and neck squamous cell carcinoma. Head Neck. 2005 Oct. 27(10):909-15. [Medline].

  14. Yousem DM, Hatabu H, Hurst RW, et al. Carotid artery invasion by head and neck masses: prediction with MR imaging. Radiology. 1995 Jun. 195(3):715-20. [Medline].

  15. Yoo GH, Hocwald E, Korkmaz H, et al. Assessment of carotid artery invasion in patients with head and neck cancer. Laryngoscope. 2000 Mar. 110(3 Pt 1):386-90. [Medline].

  16. Grubb RL Jr, Powers WJ, Derdeyn CP, Adams HP Jr, Clarke WR. The Carotid Occlusion Surgery Study. Neurosurg Focus. 2003 Mar 15. 14(3):e9. [Medline].

  17. Howlett DC, Menezes L, Bell DJ, et al. Ultrasound-guided core biopsy for the diagnosis of lumps in the neck: results in 82 patients. Br J Oral Maxillofac Surg. 2006 Feb. 44(1):34-7. [Medline].

  18. Bernier J, Bentzen SM. Radiotherapy for head and neck cancer: latest developments and future perspectives. Curr Opin Oncol. 2006 May. 18(3):240-6. [Medline].

  19. Abayomi OK. Neck irradiation, carotid injury and its consequences. Oral Oncol. 2004 Oct. 40(9):872-8. [Medline].

  20. Freeman SB, Hamaker RC, Borrowdale RB, Huntley TC. Management of neck metastasis with carotid artery involvement. Laryngoscope. 2004 Jan. 114(1):20-4. [Medline].

  21. Huvos AG, Leaming RH, Moore OS. Clinicopathologic study of the resected carotid artery. Analysis of sixty-four cases. Am J Surg. 1973 Oct. 126(4):570-4. [Medline].

  22. Snyderman CH, D'Amico F. Outcome of carotid artery resection for neoplastic disease: a meta-analysis. Am J Otolaryngol. 1992 Nov-Dec. 13(6):373-80. [Medline].

  23. Chen KY, Mohr RM, Silverman CL. Interstitial iodine 125 in advanced recurrent squamous cell carcinoma of the head and neck with follow-up evaluation of carotid artery by ultrasound. Ann Otol Rhinol Laryngol. 1996 Dec. 105(12):955-61. [Medline].

  24. Hauswald H, Simon C, Hecht S, Debus J, Lindel K. Long-term outcome and patterns of failure in patients with advanced head and neck cancer. Radiat Oncol. 2011 Jun 10. 6:70. [Medline]. [Full Text].

  25. Smyth JK, Deal AM, Huang B, Weissler M, Zanation A, Shores C. Outcomes of head and neck squamous cell carcinoma patients with N3 neck disease treated primarily with chemoradiation versus surgical resection. Laryngoscope. 2011 Sep. 121(9):1881-7. [Medline].

  26. Carvalho AL, Kowalski LP, Agra IM, Pontes E, Campos OD, Pellizzon AC. Treatment results on advanced neck metastasis (N3) from head and neck squamous carcinoma. Otolaryngol Head Neck Surg. 2005 Jun. 132(6):862-8. [Medline].

  27. Ballonoff A, Raben D, Rusthoven KE, et al. Outcomes of patients with n3 neck nodes treated with chemoradiation. Laryngoscope. 2008 Jun. 118(6):995-8. [Medline].

  28. Owen RP, Silver CE, Ravikumar TS, Brook A, Bello J, Breining D. Techniques for radiofrequency ablation of head and neck tumors. Arch Otolaryngol Head Neck Surg. 2004 Jan. 130(1):52-6. [Medline].

  29. Wust P, Stahl H, Dieckmann K, et al. Local hyperthermia of N2/N3 cervical lymph node metastases: correlationof technical/thermal parameters and response. Int J Radiat Oncol Biol Phys. 1996 Feb 1. 34(3):635-46. [Medline].

  30. Castro DJ, Sridhar KS, Garewal HS, et al. Intratumoral cisplatin/epinephrine gel in advanced head and neck cancer: a multicenter, randomized, double-blind, phase III study in North America. Head Neck. 2003 Sep. 25(9):717-31. [Medline].

  31. Jäger HR, Taylor MN, Theodossy T, Hopper C. MR imaging-guided interstitial photodynamic laser therapy for advanced head and neck tumors. AJNR Am J Neuroradiol. 2005 May. 26(5):1193-200. [Medline].

  32. Lou PJ, Jager HR, Jones L, Theodossy T, Bown SG, Hopper C. Interstitial photodynamic therapy as salvage treatment for recurrent head and neck cancer. Br J Cancer. 2004 Aug 2. 91(3):441-6. [Medline].

  33. Lamont JP, Nemunaitis J, Kuhn JA et al. Intratumoral ONYX-O15 adenovirus and chemotherapy for recurrent squamous cell carcinoma of head and neck. Ann surg oncol. 2000, Sept. 7(8):588-92.

  34. Machtay M, Rosenthal DI, Chalian AA, et al. Pilot study of postoperative reirradiation, chemotherapy, and amifostine after surgical salvage for recurrent head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2004 May 1. 59(1):72-7. [Medline].

  35. Allegretti JP, Panje WR. Electroporation therapy for head and neck cancer including carotid artery involvement. Laryngoscope. 2001 Jan. 111(1):52-6. [Medline].

  36. Ferlito A, Corry J, Silver CE, Shaha AR, Thomas Robbins K, Rinaldo A. Planned neck dissection for patients with complete response to chemoradiotherapy: a concept approaching obsolescence. Head Neck. 2010 Feb. 32(2):253-61. [Medline].

  37. Sabatini PR, Ducic Y. Planned neck dissection following primary chemoradiation for advanced-stage head and neck cancer. Otolaryngol Head Neck Surg. 2009 Oct. 141(4):474-7. [Medline].

  38. Hamoir M, Ferlito A, Schmitz S, et al. The role of neck dissection in the setting of chemoradiation therapy for head and neck squamous cell carcinoma with advanced neck disease. Oral Oncol. 2012 Mar. 48(3):203-10. [Medline].

  39. Corry J, Peters L, Fisher R, Macann A, Jackson M, McClure B. N2-N3 neck nodal control without planned neck dissection for clinical/radiologic complete responders-results of Trans Tasman Radiation Oncology Group Study 98.02. Head Neck. 2008 Jun. 30(6):737-42. [Medline].

  40. Brkovich VS, Miller FR, Karnad AB, Hussey DH, McGuff HS, Otto RA. The role of positron emission tomography scans in the management of the N-positive neck in head and neck squamous cell carcinoma after chemoradiotherapy. Laryngoscope. 2006 Jun. 116(6):855-8. [Medline].

  41. Gourin CG, Williams HT, Seabolt WN, Herdman AV, Howington JW, Terris DJ. Utility of positron emission tomography-computed tomography in identification of residual nodal disease after chemoradiation for advanced head and neck cancer. Laryngoscope. 2006 May. 116(5):705-10. [Medline].

  42. Adams G, Porceddu SV, Pryor DI, et al. Outcomes after primary chemoradiotherapy for N3 (>6 cm) head and neck squamous cell carcinoma after an FDG-PET--guided neck management policy. Head Neck. 2013 Jul 24. [Medline].

  43. Yao M, Graham MM, Hoffman HT, et al. The role of post-radiation therapy FDG PET in prediction of necessity for post-radiation therapy neck dissection in locally advanced head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2004 Jul 15. 59(4):1001-10. [Medline].

  44. Tan A, Adelstein DJ, Rybicki LA, et al. Ability of positron emission tomography to detect residual neck node disease in patients with head and neck squamous cell carcinoma after definitive chemoradiotherapy. Arch Otolaryngol Head Neck Surg. 2007 May. 133(5):435-40. [Medline].

  45. Adelstein DJ, Lavertu P, Saxton JP, et al. Mature results of a phase III randomized trial comparing concurrent chemoradiotherapy with radiation therapy alone in patients with stage III and IV squamous cell carcinoma of the head and neck. Cancer. 2000 Feb 15. 88(4):876-83. [Medline].

  46. AJCC Staging Manual. 6.

  47. Brisman MH, Sen C, Catalano P. Results of surgery for head and neck tumors that involve the carotid artery at the skull base. J Neurosurg. 1997 May. 86(5):787-92. [Medline].

  48. Brizel DM, Prosnitz RG, Hunter S, et al. Necessity for adjuvant neck dissection in setting of concurrent chemoradiation for advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2004 Apr 1. 58(5):1418-23. [Medline].

  49. Chan SW, Mukesh BN, Sizeland A. Treatment outcome of N3 nodal head and neck squamous cell carcinoma. Otolaryngol Head Neck Surg. 2003 Jul. 129(1):55-60. [Medline].

  50. Conley BA. Treatment of advance head and neck cancer: what lessons have we learned? J of Clin Oncology. 2006, March. 24(7):1023-1024.

  51. Dagum P, Pinto HA, Newman JP, et al. Management of the clinically positive neck in organ preservation for advanced head and neck cancer. Am J Surg. 1998 Nov. 176(5):448-52. [Medline].

  52. Dare AO, Gibbons KJ, Gillihan MD, Guterman LR, Loree TR, Hicks WL Jr. Hypotensive endovascular test occlusion of the carotid artery in head and neck cancer. Neurosurg Focus. 2003 Mar 15. 14(3):e5. [Medline].

  53. Derdeyn CP, Grubb RL Jr, Powers WJ. Indications for cerebral revascularization for patients with atherosclerotic carotid occlusion. Skull Base. 2005 Feb. 15(1):7-14. [Medline].

  54. Doweck I, Denys D, Robbins KT. Tumor volume predicts outcome for advanced head and neck cancer treated with targeted chemoradiotherapy. Laryngoscope. 2002 Oct. 112(10):1742-9. [Medline].

  55. Ferlito A, Buckley JG, Rinaldo A, Mondin V. Screening tests to evaluate distant metastases in head and neck cancer. ORL J Otorhinolaryngol Relat Spec. 2001 Jul-Aug. 63(4):208-11. [Medline].

  56. Gavilan J, Herranz-Gonzalez J, Lentsch EJ. Cancer of the neck. Cancer of the head and neck. 4th edition: Saunder Co; 2003. 407-430.

  57. Giatromanolaki A, Koukourakis MI, Georgoulias V, Gatter KC, Harris AL, Fountzilas G. Angiogenesis vs. response after combined chemoradiotherapy of squamous cell head and neck cancer. Int J Cancer. 1999 Mar 15. 80(6):810-7. [Medline].

  58. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. The Department of Veterans Affairs Laryngeal Cancer Study Group. N Engl J Med. 1991 Jun 13. 324(24):1685-90. [Medline].

  59. Lau H, Phan T, Mackinnon J, Matthews TW. Absence of planned neck dissection for the N2-N3 neck after chemoradiation for locally advanced squamous cell carcinoma of the head and neck. Arch Otolaryngol Head Neck Surg. 2008 Mar. 134(3):257-61. [Medline].

  60. Lesley WS, Chaloupka JC, Weigele JB, Mangla S, Dogar MA. Preliminary experience with endovascular reconstruction for the management of carotid blowout syndrome. AJNR Am J Neuroradiol. 2003 May. 24(5):975-81. [Medline].

  61. Lore JM Jr, Boulos EJ. Resection and reconstruction of the carotid artery in metastatic squamous cell carcinoma. Am J Surg. 1981 Oct. 142(4):437-42. [Medline].

  62. McHam SA, Adelstein DJ, Rybicki LA, et al. Who merits a neck dissection after definitive chemoradiotherapy for N2-N3 squamous cell head and neck cancer?. Head Neck. 2003 Oct. 25(10):791-8. [Medline].

  63. Moore MG, Bhattacharyya N. Effectiveness of chemotherapy and radiotherapy in sterilizing cervical nodal disease in squamous cell carcinoma of the head and neck. Laryngoscope. 2005 Apr. 115(4):570-3. [Medline].

  64. Morrissey DD, Andersen PE, Nesbit GM, Barnwell SL, Everts EC, Cohen JI. Endovascular management of hemorrhage in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg. 1997 Jan. 123(1):15-9. [Medline].

  65. Nussbaum ES, Levine SC, Hamlar D, Madison MT. Carotid stenting and "extarterectomy" in the management of head and neck cancer involving the internal carotid artery: technical case report. Neurosurgery. 2000 Oct. 47(4):981-4. [Medline].

  66. Okamoto Y, Inugami A, Matsuzaki Z, et al. Carotid artery resection for head and neck cancer. Surgery. 1996 Jul. 120(1):54-9. [Medline].

  67. Pellitteri PK, Ferlito A, Rinaldo A, et al. Planned neck dissection following chemoradiotherapy for advanced head and neck cancer: is it necessary for all?. Head Neck. 2006 Feb. 28(2):166-75. [Medline].

  68. Pitman KT, Bradley PJ. Management of the N3 neck. Curr Opin Otolaryngol Head Neck Surg. 2003 Apr. 11(2):129-33. [Medline].

  69. Robbins KT, Clayman G, Levine PA, et al. Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. Arch Otolaryngol Head Neck Surg. 2002 Jul. 128(7):751-8. [Medline].

  70. Serin M, Erkal HS, Cakmak A. Radiation therapy, cisplatin and hyperthermia in combination in management of patients with recurrent carcinomas of the head and neck with metastatic cervical lymph nodes. Int J Hyperthermia. 1999 Sep-Oct. 15(5):371-81. [Medline].

  71. Shah J. Cervical lymph nodes. In: Head and Neck Surgical Oncology. Mosby Co. 2003. 353-393.

  72. Stell PM. Fixed, bilateral cervical nodes. J Laryngol Otol. 1983 Sep. 97(9):851-6. [Medline].

  73. Thompson SK, McKinnon JG, Ghali WA. Perioperative stroke occurring in patients who undergo neck dissection for head and neck cancer: unanswered questions. Can J Surg. 2003 Oct. 46(5):332-4. [Medline].

  74. Thompson SK, Southern DA, McKinnon JG, Dort JC, Ghali WA. Incidence of perioperative stroke after neck dissection for head and neck cancer: a regional outcome analysis. Ann Surg. 2004 Mar. 239(3):428-31. [Medline].

 
Previous
Next
 
Levels of metastasis to cervical lymph nodes.
Table 1. Staging
Stage Tumor Node Metastasis
Stage I T1 N0 M0
Stage II T2 N0 M0
Stage III T3 N0 M0
  T1 N1 M0
  T2 N1 M0
  T3 N1 M0
Stage IVa T4a N0 M0
  T1 N1 M0
  T2 N2 M0
  T3 N2 M0
  T4a N2 M0
Stage IVb Any T N3 M0
  T4a Any N M0
Stage IVc Any T Any N M1
Table 2. Type of Neck Dissection Chosen as Dictated by What Structures are Involved
Type of Neck Dissection Nodes Removed Structures Sacrificed
Radical level I-V Cranial nerve XI, internal jugular, sternocleidomastoid
Modified radical level I-V Cranial nerve XI, internal jugular, sternocleidomastoid(preserve at least one)
Selective neck Preservation of nodal levels None
Extended radical level I-V +/- mediastinal, retropharyngeal, perifacial, level VI Cranial nerve XI, internal jugular, sternocleidomastoid +/- carotid, skin, cranial nerve XII, cranial nerve X, paraspinal muscle
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.