Clinicopathological evaluation of cervical nodal metastasis in pharyngeal and laryngeal tumours

AIMS AND OBJECTIVES • To determine the incidence of cervical node metastasis by the site of primary. • To describe the distribution of neck node secondaries by the site of primary. • To correlate individually the size of tumour with the incidence of cervical node metastasis and the time of initial presentation. • To determine the different types of malignancy. DESIGN OF STUDY PRIMARY PURPOSE: Clinicopathological evaluation PERIOD OF STUDY : From November 2010 to November 2011. SELECTION OF STUDY SUBJECTS: Ages Eligible for Study : 18 Years to 80 Years Genders Eligible for Study : Both Total no of patients included in the study : 61 Inclusion Criteria: All patients presenting with swelling in the neck with palpable nodes more than 1 cm in size, firm to hard in consistency and spherical rather than ovoid. All patients with palpable nodes in the site of drainage of the primary. Exclusion Criteria: Inability to fully evaluate or confirm diagnosis by histology. DATA COLLECTION: Through clinical examination followed by biopsy and FNAC reports. METHODOLOGY A detailed history was obtained including information as to whether the patient had ENT, respiratory, gastrointestinal or urinary symptoms. A complete physical examination was then carried out including a postnasal examination and an indirect laryngoscopy for characteristics of primary in terms of site, extent, size, macroscopic appearance, degree of local infiltration, presence of synchronous lesion and the T Stage. The palpable nodes were considered significant if they were more than 1 cm in size, firm to hard in consistency, spherical rather than ovoid and those in the site of drainage of the primary. The important features noted regarding the nodes during palpation include the location, level of the node, size, consistency, number of nodes and the group to which they belong, as well as signs of extracapsular spread such as invasion of the overlying skin, fixation to deeper tissues or paralysis of cranial nerves or sympathetics. The presence of contralateral nodes and the N-stage was also determined. The clinical impression of the first observer was confirmed by atleast one other observer. A fine needle aspiration cytology of the nodes was then done. Biopsy from the primary site was done in all cases to know the nature and degree of differentiation of the primary. RESULTS Out of the 61 patients selected for the study, males predominate over females with a male to female ratio of 5.8:1. The age incidence is identical to that seen in the West with the maximum incidence in the sixth decade. CONCLUSION Majority of the cervical metastases were due to Squamous cell carcinoma of the head and neck. Certain primary sites have a predilection for certain groups of nodes. Incidence of cervical node metastasis was highest for Nasopharyngeal tumours (100%), followed by Hypopharynx (83%), Oropharynx (82%) and Larynx (71%). In most of the cancers in the study, it is observed that increasing size of the primary had increasing number of nodes as well as an increasing nodal stage