Incidence Of Cervical Lymph Node Metastasis In Sudanese Patients With Oral And Pharyngeal Cancers

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Date
2015-03-31
Authors
Ahmed, Abdelgadir
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Publisher
UOFK
Abstract
Cervical lymph node metastasis has the utmost prognostic significance in oral and pharyngeal cancers. It is the commonest presenting feature in these tumors and has a major effect in planning management of these patients. This is a prospective cross-sectional study conducted in Khartoum E.N.T, Ibnsina, Khartoum Dental and Wad Medani hospitals during 15 months, from March 2001 to June 2002. It was designed to study the incidence of cervical lymph node metastasis in oral and pharyngeal cancers, to evaluate the factors which may affect it and to study the relation of the involved neck nodes with the primary tumor. Patients who presented with symptoms and signs of oral and pharyngeal cancers and/or cervical lymph node enlargement were examined. Biopsy from the primary tumor was taken for all patients and submitted for histological examination. The incidence of cervical lymph node metastasis in the nasopharynx was 85%, oropharynx 71%, hypopharynx 42% , oral cavity 37% and the overall incidence was 58.6%. Eighty six percent of the tumors were Squamous cell carcinoma, 60% of which had cervical lymph node metastasis. The incidence of cervical lymph node metastasis according to the size of the primary tumor was found to be as follows: 1.Oral cancer: T1 (0%) , T2 (66%) and T3(33%). 2.Nasopharyngeal cancer: T0 (66%), T1 (100%) , T2 (75%) and T3 (86%). 3.oropharyngeal cancer: T2 (100%), T3 (67%). No patient presented with T0 or T1 tumor. 4.Hypopharyngeal cancer: T0 (0%) , T1(16.7%), T2 (50%) and T3 (75%). According to the histology of the primary tumor, the incidence of cervical lymph node metastasis was found to be as follows: 1.Oral cancer: WDSCC (50%), MDSCC (50%) and PDSCC (100%). The percentage for verrucus , adenoid cystic, mucoepidermoid carcinoma and lymphoma was 0%. 2.Nasopharyngeal cancer: WDSCC (66%), MDSCC (50%), PDSCC (92%) and Non-Hodgkin's lymphoma (100%). 3.Oropharyngeal cancer: WDSCC (66%), MDSCC (100%) and PDSCC (66%). 4.Hypopharyngeal cancer: WDSCC (33%), MDSCC (50%) and PDSCC (25%) and leiomyosarcoma (100%). Level II was the most commonly involved site (43%). In nasopharyngeal carcinoma, level II, III and V were found to be predominantly involved; (39%), (29%) and (18%) respectively. In hypopharyngeal cancer level I was involved in (11%) of patients, level II (56%), level III (22%) and level IV (11%). In oropharyngeal cancer level I was involved in (22%) of patients, level II (44%), level III (22%) . In oral cancer level I was commonly involved (44%), followed by level II (33%) and level III (22%). In conclusion, cervical lymph node metastasis was a common presenting feature of oral and pharyngeal cancers. Most patients presented late . The site of the primary tumor was found to be the most important factor in determining the incidence of cervical lymph node metastasis in oral and pharyngeal cancers, the size and histological differentiation of the primary tumor were important but had variable effect. The site of the primary tumor could be broadly predicted from the level of the involved neck nodes. Level II was the commonest level involved in oral and pharyngeal cancer in Sudan.
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89page
Keywords
Incidence,Cervical,Lymph, Node, Metastasis
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