Lymphatic Metastasis in Oropharyngeal Squamous Cell Carcinoma (OPSCC)

  • Lymph node metastases:
    • At presentation are common in OPSCC:
      • With over half of patients:
        • Having clinical or radiological evidence of cervical metastasis, and
      • Around a third of patients diagnosed as cN0:
        • Having pathologic evidence of lymph node metastasis
    • The lymphatic drainage from the oropharynx:
      • Is mainly to:
        • Levels II, III and IV
      • It also drains into:
        • The retropharyngeal (RP) nodes:
          • Which need to be considered in the assessment of disease in this area
          • The risk of metastasis to RP lymph nodes depends on subsite:
            • A meta-analysis of papers suggests risk of RP lymphadenopathy being:
              • 19% for soft palate
              • 12% for tonsil
              • 6% for base of tongue and
              • 21% to 57% for posterior pharyngeal wall tumors:
                • Including hypopharynx
        • The prognostic impact of positive RP lymph node metastasis is disputed:
          • Some authors showing an adverse impact:
            • And others not
    • A particular feature of OPSCC:
      • Is the propensity to metastasis to the contralateral neck:
        • This occurring in up to 30% of patients overall in one series:
          • The subsites in which this is mostly likely to occur are the:
            • Soft palate
            • Base of tongue
            • Posterior pharyngeal wall:
              • However:
                • Even tonsil cancers have an approximate rate:
                  • Of contralateral nodal spread of 10%

#Arrangoiz #HeadandNeckSurgeon #HeadandNeckCancer #CancerSurgeon #SurgicalOncologist

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