JIPMER Onco

Lymph nodes in neck

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Q) Most common site for lymph node spread is ? (head and neck Onco) 

a) Tongue

b) Lip

c) NAsopharynx

d) Glottis

Ans c

 Primary sites within the pharynx (i.e., nasopharynx, oropharynx, and hypopharynx) and supraglottic larynx  are particularly high risk.

The oral cavity has an intermediate risk,

whereas the glottic larynx, nasal cavity, and paranasal sinuses are low risk. Other predictors of risk of metastases are higher T stage and thickness (in case of oral cavity cancers).

TNM Nasopharyngeal Carcinoma

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Nasopharyngeal Carcinoma TNM Staging MCQ | NEET SS Surgery
HEAD AND NECK SURGERY MCQ | NEET SS

Nasopharyngeal Carcinoma: TNM Staging

A 3.5 cm mass is identified in the nasopharynx, extending into the left nasal cavity. Imaging also reveals a 4.5 cm lymph node in the supraclavicular region. What is the correct TNM staging of this nasopharyngeal carcinoma?

A. T1N1
B. T1N3
C. T2N1
D. T2N3

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Nasopharyngeal Carcinoma TNM Staging: Important Exam Notes

Nasopharyngeal carcinoma is staged using the TNM system, which assesses the primary tumour (T), regional lymph nodes (N) and distant metastasis (M). Correct staging requires assessment of the anatomical extent of the primary lesion and the size, location and distribution of involved nodes.

Primary tumour classification

  • T1: Tumour confined to the nasopharynx or extending into the nasal cavity and/or oropharynx without parapharyngeal extension.
  • T2: Parapharyngeal extension and/or involvement of adjacent soft tissues.
  • T3: Involvement of skull base bone, cervical vertebrae, pterygoid structures or paranasal sinuses.
  • T4: Intracranial or cranial nerve involvement, orbital extension, hypopharyngeal involvement, parotid involvement or extensive soft-tissue disease.

Regional lymph node classification

Nodal staging considers the anatomical level of the involved nodes, their laterality, size and extension relative to defined anatomical landmarks. A 4.5 cm node does not qualify as N3 on size alone. The location must be assessed against the applicable staging criteria.

Important examination pearl

Extension into the nasal cavity alone is compatible with T1 disease. Do not upgrade to T2 without the relevant additional anatomical extension. Likewise, a description of a supraclavicular node should be interpreted using its precise anatomical location rather than its label alone.

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Head and neck SCC

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Q) Which treatment regimen is commonly recommended for radiotherapy (RT) in patients with Head and Neck Squamous Cell Carcinoma (SCC)?
A. Concurrent
B. Adjuvant
C .Neoadjuvant
D. Sequential