DISTRIBUTION OF CERVICAL LYMPH NODE
METASTASES FROM SQUAMOUS CELL
CARCINOMA OF THE UPPER RESPIRATORY
AND DIGESTIVE TRACTS
The records of 2,044 patients with previously untreated squamous cell car-
cinomas of the head and neck were reviewed in order to define the incidence
and topographical distribution of lymph node metastasis on admission. The
common regions of metastasis are presented for each of the seven individual
head and neck sites selected for study. Knowledge of the preferred areas
of spread and those that are almost never involved allows the design of more
adequate plans to manage the individual lesions.
HE PURPOSE OF THIS REPORT IS TO DEFINE
T the incidence and topographical distribu-
tion of lymph node metastasis on admission in
patients with squamous cell carcinomas of the
major anatomical sites of the upper respira-
tory and digestive tracts.
The records of 2,044 patients with pre-
viously untreated squamous cell carcinoma of
the head and neck, seen from 1948 through
1965 at The University of Texas at Houston
M. D. Anderson Hospital and Tumor Insti-
tute, were reviewed. Seven major head and
neck regions were studied: oral tongue, floor
of mouth, faucial arch, oropharynx proper, su-
praglottic larynx, hypopharynx, and nasophar-
ynx. The nodal staging system (Table 1) has
been used since the mid-1950’s. A “clinically
positive” lymph node is usually greater than 1
cm, spherical rather than a flat ovoid, and
harder than the nonmetastatic lymph node.
Presented at the Scientific Program of the Amcrican
Society of Therapeutic Radiologists, Phoenix, Ariz.,
Oct. 28-31, 1971.
From the Department of Radiotherapy, The Univer-
sity of Texas at Houston M. D. Anderson Hospital and
Tumor Institute, Houston, Tex.
Supported by Grants No. CAW294 and CA05654,
from the National Cancer Institute, National Institute;
of Health, U. S. Public Health Service.
+ Radiotherapist and Associate Professor o€ Radio-
Address for reprints: Robert Lindberg, MD, The De-
partment of Radiotherapy, The University of Texas at
Houston M. D. Anderson Hospital and Tumor Insti-
tute, Houston, Tex. 77025
Received for publication January 20, 1972.
OF NECK DISEASE
SITE AND T STAGING
The incidence of cervical node metastasis
on admission increases sharply as the size of
the primary increases in lesions o f the oral
tongue, floor of mouth, retromolar tri-
gone/anterior faucial pillar (RMT-AFP),
and soft palate (Tables 2 and 3). The fre-
quency of multiple unilateral as well as bilat-
eral and/or fixed node metastases also in-
creases with the size of the primary for the
same sites. The incidence of multiple nodal
metastases in lesions of the tonsillar fossa, base
of tongue, supraglottic larynx, and hypophar-
ynx is not strongly correlated with the staging
of the primary. This lack of correlation re-
flects the aggressiveness of the primary lesions.
In oropharyngeal wall lesions, even though
the incidence o f metastases relates well to the
increasing T stage, the multiplicity of nodes is
not as strongly related. The incidence of TIN,
lesions of the supraglottic larynx appears dis-
proportionately high (Table 4). A lesion is
classified T4 because of the local extension,
i.e., pre-epiglottic involvement. The bulk of
I ABLE 1. Nodal Staging System
clinically positive node.
N1-Single clinically positive node
clinically positive node > 3 cni in
3 cni in
cliiiically positive ipsilateral nodes.
fixed node (s) clinically positive.
positive bilateral nodes, fixed or not