• Nalaka de Silva

Neck Node

Updated: Jun 16, 2019

Please note that the following is a general guideline only.




Epidemiology

> 40 Yr neck node is a malignancy Unless proven otherwise, M>F

>40 Yr Cystic mass in the neck is a degenerated cancer node, not a branchial cyst until proven otherwise

In the young -Inflammatory more likely, if cystic- branchial cyst




Aetiology

Most common mets are SCC > others ie thyroid/ adeno Ca/ melanoma

SCC=Primary sites nasopharynx > tonsil > retromolar trigone > tongue base > piriform sinus Then outside head and neck

Primary lymphoma-less common

Inflammatory; bacterial/ viral/ TB should be considered)





Signs and Symptoms

Hx suggestive more of an inflammatory node are : acute onset, painful, resolving, younger patient

Hx suggestive of a neoplasm- progressive enlargement, generally non tender, SCC hard, may get cystic degeneration Lymphoma rubbery.

Ask about symptoms of a possible primary site;

-upper aerodigestive tract: Dysphagia, Otalgia due to referred pain

-Skin CA

-Thyroid cancer/risk of cancer




Examination




Node or nodes: what is the consistency, is it very tender(inflammatory)

Look for a primary site (oral cavity, oropharynx, Flexible scope: nsopharynx, Hypopharynx, larynx, skin, thyroid, melanoma)

If a low neck node look for a primary breast/ chest/ GI/ testicular origin












Investigation

If acute onset may observe/ do blood work up check for EBV, CMV etc

US guided FNAC: (if any possibility of neoplasm) : do all the stains-Cytokeration-SCC, Lukocyte antigens-lymphoma, HMB45, s 100-melanoma, Thyroid AB

Also consider TB culture on FNA

If non diagnostic need and excisional biopsy and through look for a primary site i.e. Panendoscopy & blind biopsies of the nasopharynx, tongue base, tonsillectomy (wide resection)

Cystic mets have poor FNA diagnostic yield and do need an excisional biopsy (cystic node in an adult is cancer unless proven otherwise; NOT a branchial cyst!)

If low cervical nodes/ adeno CA on FNA: work up for non-head and neck primary (chest/ prostate/ renal/ GI/ breast)





Treatment

Metastatic SCC; Neck dissection, treatment of the primary site and XRT +/- Chemotherapy

If Thyroid: need total thyroidectomy, neck dissection and post op radioactive treatment

if Lymphoma -CHOP etc






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