AAO-HNSF Primary Care Otolaryngology Handbook

CHAPTER 15

Metastasis Squamous cell carcinoma tends to metastasize early, first to the lymph nodes of the neck followed by the lung, liver, bone, and brain. For advanced disease, a metastatic workup is essential. This may include a CT scan of the neck and chest or whole-body CT-PET combined imaging. If the tumor has metastasized to the lungs or liver, the role of surgery is limited to palliation. Fortunately, the lungs are infrequently involved with metastatic disease at the time of initial diagnosis. If the metastases are confined to the lymph nodes of the neck (the most common scenario), then a neck dissection to remove all of the cervical lymph nodes is performed. A radical neck dissection is performed when bulky metas- tasis demands surgery that includes removal of the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve. For more on neck dissection, consult the free AAO–HNSF e-book TNM Staging of Head and Neck Cancer and Neck Dissection Classification (5th edition), visit www. AcademyU.org and search eBooks to access now.

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Primary Care Otolaryngology