REGIONAL METASTATIC DISEASE OF THE NECK NECK DISSECTION Éva Remenár MD, PhD Multidisciplinary Head and Neck Cancer Center National Institute of Oncology, Budapest

Head and neck cancer Common >90% of all HN cancers: squamous cell cancer of the upper aerodigestive tract mucosa Oral cavity (C00-C06) Oropharynx (C01, C05, C09, C10) Hypopharynx (C12, C13) Larynx (C32) Rare head and neck cancer Nasopharynx (C11) Nasal cavity and sinuses (C30, C31) Salivary glands (C07, C08) Cancers of other organs of origin, localized on the head and neck Skin (C43, C44) Soft tissue and bone tumors (C49, C41) Thyroid gland (C73)

HEAD AND NECK CANCER INCIDENCE AND MORTALITY IN HUNGARY (National Cancer Registry and KSH Demographic Yearbook 2010) Incidence Frequency Mortality Oral cavity and pharynx, males (ICD: C00-C14) 2454/2740 (89,6%) 4. 1339 3. Larynx, males (ICD: C32) 999 10. 482 Oral cavity and pharynx, females (C00-C14) 660/946 (69,7%) 12. 246 14. Larynx, females 211 21. 62 24.

EARLY STAGE ORAL CARITY CANCERS 4

ADVANCED STAGE ORAL CAVITY CANCER 5

ADVANCED STAGE CANCER OF THE SUBLINGUAL AREA 6

ADVANCED STAGE CANCER OF THE LARYNX

ADVANCED STAGE CANCER OF THE LEFT PIRIFORM SINUS

ADVANCED STAGE CANCER OF THE PAROTID GLAND

NECK (REGIONAL) METASTASIS The presence of regional neck metastasis is the most important bad prognostic factor in head and neck squamous cell cancer At the time of the diangosis of head and neck cancer >60% of the patients have regional disease on the neck At least 50% of the patients loco-regional reccurrence within 3 years Consequently the effective treatment of the neck metastases is very important for the patient

REGIONAL METASTASIS AND THE PRIMARY SITE OF CANCER

TNM STAGING

TNM STAGING

TNM TAGING

DEEPLY (> 6 mm) INFILTRATING CANCER

LYMPHATIC LEVELS AND SUBLEVELS OF THE NECK Level I sublevel IA: submentalis sublevel IB: submandibularis Level II: upper parajugular sublevel IIA: jugulo-digastric sublevel IIB: submuscular (m. scm) recess Level III: medium parajugularis Level IV: lower parajugularis Level V: posterior triangle sublevel VA: accessory sublevel VB: transverse cervical and supraclavicular Level VI: medial compartment Level VII: upper mediastinal Robbins RT et al: Consensus Statement on the classification and terminology of neck dissections. Arch Otolaryngol Head Neck Surg 2008; 134: 536-538 16

CLASSIFICATION OF NECK DISSECTIONS Radical neck dissection: I-V levels and m. scm, v. jugularis interna, n. accessorius eltávolítása Modified radical neck dissection: I-V levels but preservation of at least one of the followings: int. Jugular vein, accessory nerve, m. scm Selective neck dissection: preservation of at least one level of the neck Extended neck dissection: excision of orgas that are usually not part of a radical neck dissection Robbins KT et al: Neck dissection classification update. Arch Otolaryngol Head Neck Surg 2002; 128: 751-758 Robbins RT et al: Consensus Statement on the classification and terminology of neck dissections. Arch Otolaryngol Head Neck Surg 2008; 134: 536-538

RADICAL NECK DISSECTION 18

MODIFIED RADICAL NECK DISSECTION m. sternocleidomastoideus resected, Preserved structures: V. jugularis interna (IJV) N. accessorius (SAN) SAN IV 19

SELECTIVE NECK DISSECTION m. sternocleidomastoideus resected, Preserved structures: V. jugularis interna (IJV) N. accessorius (SAN) SAN IJV

SECTIVE NECK DISSECTION Level II-III (SND) Preserved structures: m. sternocleidomastoideus (SCM) v. jugularis interna (IJV) N. accessorius (SAN) SAN IJV SCM

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