This document discusses primary and secondary tumors of the neck. Primary neck tumors originate in the head or neck itself, such as in the thyroid or larynx, and often spread to neck lymph nodes. Secondary neck tumors have spread from primary cancers elsewhere, like the lung or breast. Risk factors include tobacco use and heavy alcohol consumption. Primary neck cancers are typically evaluated with examinations and biopsies, while secondary cancers may require investigations to identify the original primary site. Treatment approaches include surgery, radiation, chemotherapy, or palliation depending on the specific cancer type and stage.

1. Primary And Secondary Tumors
Of Neck
Dr Tridip Dutta Baruah
Asst Prof, Dept Of Surgery
MGMCRI

2. What are Primary Neck Tumors?
 Primary tumors originate in the head or neck
itself, including the thyroid, throat, larynx,
salivary gland or other locations.
 Primary tumors of the head and neck typically
spread to the lymph nodes in the neck.

3. Common Sites Of Neck Primary
1. OralCavity, Toungue and Tonsils
2. Salivary Glands
3. Pharyx and Nasopharynx
4. Larynx
5. Oesophagus
6. Thyroid

4. What are secondary tumors ?
 Secondary cancers are tumors that have spread
from primary tumors in other parts of the body
to the head or neck.
 Most often, secondary tumors of the neck
originate in the lung, breast, kidney, or from
melanomas in the skin.
 Cancers in the nasal and sinus passages may
spread to the brain through nerves in the skull.

5. Histological Types Of Secondaries
1. Squamous cell carcinoma(Mainly from oral
cavity and pharynx)
2. Adenocarcinoma(From GIT and usually
involves left supraclavicular lymph nodes)
3. Rarely Melanoma

6. Risk Factors
 Tobacco and heavy alcohol use are the most
common risk factors for head and neck cancer.
 This includes all tobacco products including
cigarettes, cigars and chewing tobacco.
 Cigarette smokers have a lifetime increased risk
for head and neck cancers 5-25 times over the
general population
 Ex-smokers risk for head and neck cancer begins
to approach the general population 20 years
after quitting tobacco

7. Additional Risk Factors
 Leukoplakia (1/3 develop oral cancer
 M > F (2-3 times risk)
 Age > 40
 Betel nut chewing
 Occupational inhalant exposures including nickel
refining, textile fibers and woodworking dust

8. Clinical Presentation
 Patients generally present with a painless,
solitary neck mass, most often discovered by
the patient.
 Masses are usually at least 2-3 cm
 Patients have usually gone through at least
one course of antibiotics
 Benign masses are also often solitary and
painless

9. Features Of Secondaries Of Neck
1. Age: Elderly male. Commonly presents with rapidly
growing painless swelling in the neck.
2. Swelling has nodular surface, hard in consistency and
often fixed.
3. Secondaries can infiltrate muscles, post vertebral
muscles, nerves such as spinal acessory and
hypoglossal and sometimes cervical sympathetic
chain.
4. It can spread to surrounding soft tissue causing
fungation and ulceration.
5. In advanced cases can infiltrate major blood vessel
such as carotid or one of its branches causing
torrential haemorrahge.

10. Symptoms Of Secondaries Of Neck
Patient May present with
1. Horseness: carcinoma Larynx or Thyroid
2. Dysphagia: Carcinoma post 1/3 of toungue,
Pharynx and esophagus
3. Haemoptysis, cough and dypsnoea: Carcinoma
Lung
4. Ear pain and deafness: Nasopharyngeal
carcinoma.
5. Involvent of 7/11/12 Cranial nerves and
Sympathetic chain.

11. Levels of the Neck

12. Relationship of Node Location to
Likely Disease
 Nodes at certain levels more likely certain
primaries
 Upper neck nodes are the most likely to be
head and neck cancer
a) Subdigastric node may be virtually any head
and neck primary, or a non-Hodgkin’s
lymphoma
b) Submandibular node suggests oral cavity,
lip, nasal vestibule or salivary gland primary
c) Submental nodes are uncommon

13. Relationship of Node Location to
Likely Disease
 Mid Neck
Likely primaries include larynx, hypopharynx, and less
commonly esophagus, disease below clavicles or
lymphoma
 Lower Neck and Supraclavicular Nodes
a) Most often metastatic from chest or abdomen,
possible esophagus or lymphoma. A primary head
and neck node is uncommon at this level
b)Parotid lymph nodes are more likely skin cancer
than from a primary parotid tumor
c)Benign neck masses are most common except in
supraclavicular lymph nodes

14. Head and Neck Cancer- Squamous
Cell.Carcinoma
 6th most common cancer worldwide.
 HNSCC ~ 5% all cancers
 S.C.C most common upper aero digestive tract
malignancy
 Smoking and 50% HNSCC occur in oral cavity
 Management presents considerable functional
and aesthetic problems
 Multidisciplinary approach imperative

15. Treatment of Head and Neck -
Squamous Cell Carcinoma
 Removal of Primary tumor + cervical nodes
 Surgery / Radiation / Chemotherapy
 Sometimes palliation
 Cervical neck disease reduces survival by 50%

16. Lymphomas
 Lymphomas are malignant cell infiltrations of the
lymphatic system.
 Once a malignancy begins in one part of the
lymph system, it often spreads throughout the
rest of the system before it is detected.
 Lymphomas share similar symptoms such as
painless swelling of the lymph nodes, fever and
fatigue.
 Broadly, they are classified as either non-
Hodgkin's and Hodgkin's.

17. Types Of Neck Secondaries
I. Seconadaries with known Primary
II. Secondaries with clinically unknown Primary
III. Secondaries with Occult Primary

18. I. Secondaries With Known Primary
 Here secondary are present and primary
identified in oral cavity, pharynx, larynx and
other areas.
 Biopsy of primary and FNAC of secondary are
done.
 Primary treated accordingly by surgery or
radiotherapy.
 Secondaries when mobile are treated by
Radical lymph node block dissection.

19. II. Secondary With Clinically Unidentified
Primary
 FNAC of the secondary done and primary searched
by investigations.
 Investigations done are-
a. Laryngo-pharyngoscopy
b. Oesophagoscopy
c. Bronchoscopy
d. Blind biopsy from lat wall of pharynx, Fossa of
Rosenmuller,Pyriform Fossa,Tonsil and larynx
e. FNAC of thyroid.
f. CT Scan

20. III. Secondaries Of Neck With Occult
Primary
 Here secondary in the neck lymph node confirmed by
FNAC but primary not revealed by any available
investigations.
 Initially secondaries if mobile treated with radical
lyph node dissection and regular follow up done at
three monthly interval till primary is revealed.
 If lymph node when fixed is inoperable then external
radiotherapy given to palliate pain and to prevent
anticipated bleeding and sometimes it downstages
the sewlling which can be delt with block dissection
later.
 Primary when revealed is treated accordingly.