Patterns of spread of distant metastases in head and neck cancer

TLDR

The study examined adults with epithelial head and neck tumors, reviewing all head and neck sites except paranasal sinuses, eye, ear, and thyroid. Among 779 head and neck cancer patients, 12.3% developed distant metastases, most commonly to lungs, bone, and liver, with unexpected involvement of heart, spleen, and gastrointestinal tract; advanced T4 tumors and patients with controlled primaries were particularly prone, and autopsies revealed additional metastatic sites.

Abstract

Ninety-six (12.3%) of a total of 779 patients with head and neck cancer were found (clinically or at autopsy) to have distant metastases in the period from 1955 to 1967, in a study at the Division of Radiation Therapy, Stanford University School of Medicine. The study was confined to adults with epithelial tumors. All areas in the head and neck region were reviewed, except the paranasal sinuses, eye, ear, and thyroid gland. Metastases to the lungs, bone, and liver were the most common, but unexpected metastases to the heart, spleen, and gastrointestinal tract were frequently found. The most advanced primary tumors (T4) were most likely to have metastases. More than 50% of patients in whom the primary site was effectively controlled developed metastases. Forty patients of the 96 with metastases had an autopsy; further metastatic sites, not apparent clinically, were found in most of these patients.