Neck Condition (Neoplastic Lymphadenopathy)

What is neoplastic lymphadenopathy?

Lymphoma
This is a primary malignant tumour of the lymphatic tissues.

Sign and Symptoms

Multiple nodes of a rubbery consistency. The patient may or may not experience night sweats, weight loss, axillary or groin nodes, and lethargy.

Investigations

FNAC may be suspicious but an excision biopsy is often required to confirm the diagnosis and allow for sub typing. A CXR and/or a chest CT scan may be done, or, for staging, a CT scan of the abdomen or pelvis. Bone marrow may be needed for staging.

Treatment

May involve chemotherapy and/or radiotherapy. The patient may need a lymphoma multi-Disciplinary Team review.

What is squamous cell carcinoma

This a primary muco-cutaneous malignancy which commonly spreads to local lymph nodes. It can affect single or multiple nodes.

Signs and Symptoms

The patient may have ENT-related symptoms such as a sore throat, a hoarse voice or otalgia. The nodes may have a firm or hard consistency. The patient may have a history of smoking.

Investigations

These may include FNAC , ENT examination looking for ENT primary carcinoma, a CT or MRI scan of the neck, a CT scan of the chest and/or CXR (metatases), a liver USS (metatases), a panendoscopy and biopsy.
Where no ENT primary is seen on examination, a rigorous search should be done for a silent tumor. This will usually involve imaging as above with ipsilateral tonsillectomy, biopsy of the tongue base, post nasal space and piriform fossa as a minimum.

Treatment

This depends on the stage, the size and the site of the primary. Options for treatment include:
Radiotherapy: this involves 4-6 weeks of daily treatment with a total dose of 50-60Gy.

Radical neck dissection: this involves removing the affected nodes as well as all the other nodal groups and lymph-bearing structures on that side od the neck. This includes the lymph nodes at level 1, 2, 3, 4, and 5, the internal jugular vein (IJV), the Sternomastoid and the accessory nerve.

Modified radical neck dissection: this takes all the nodal levels (1, 2, 3, 4, 5) but preserves one or all of the IJV, the sternomastoid and the accessory nerve.

Selective neck dissection: Instead of all the nodal groups being removed, those groups thought to be at most risk are selectively dissected and removed. All other structures are preserved.


N staging of the neck

N1 - a single node< 3cm
N2a - a single node>3cm but <6cm
N2b - >1 ipsilateral node <6cm
N2c - Bilateral or contralateral nodes <6cm
N3 - Any node >6cm