Introduction

The management of head and neck cancer is a multidisciplinary process. The role of surgery versus radiotherapy and/or chemotherapy in the treatment of head and neck squamous cell cancer largely depends on the localization and stage of the lesion. Imaging findings, essential to determine as precise as possible the local and regional extent of the cancer, may profoundly influence the therapeutic decision process. If surgery is included in the patient management, imaging findings are very helpful in determining the optimal approach and anticipating technical difficulties during resection.

Management of cervical metastasis

The status of the regional lymphatics is one of the most important prognostic indicators in patients with squamous carcinomas arising from the epithelium of the upper aerodigestive tract (oral cavity, oropharynx, hypopharynx and larynx). The presence of regional metastases results in cure rates that are approximately half of those obtainable if metastastes to the regional lymphatic are absent.

In order to establish a consistent and easily reproducible method for description of regional cervical lymph nodes, providing a common language between the clinician, the pathologist and radiologist, the Head and Neck Service at Memorial Sloan-Kettering Cancer Center has described a leveling system for the cervical lymph nodes. This system divides the lymph nodes into seven nodal groups or levels (see also Chs. 1 and 7).

Physical examination of the neck for lymph node metastases has variable reliability.