What are the key levels of cervical lymph nodes. How are cervical lymph nodes classified anatomically. Which cancers are associated with specific lymph node levels. How does imaging aid in cervical lymph node assessment.

Cervical Lymph Node Classification: An Overview

The classification of cervical lymph nodes is crucial for understanding head and neck anatomy, diagnosing various conditions, and planning treatments for cancers in this region. The American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery have proposed a standardized nomenclature that divides the neck into 10 distinct lymph node groups or levels. This system provides a comprehensive framework for describing the location of lymph nodes and their potential involvement in various pathological processes.

Each level is defined by specific anatomical boundaries and is associated with particular primary tumor sites that may metastasize to those nodes. Understanding these levels is essential for radiologists, oncologists, and surgeons involved in the management of head and neck cancers.

Key Anatomical Landmarks for Cervical Lymph Node Mapping

To accurately identify and describe cervical lymph node levels, several important anatomical landmarks are used as reference points:

• Hyoid bone
• Cricoid cartilage
• Carotid arteries
• Sternocleidomastoid muscle
• Manubrium of sternum

These structures serve as boundaries and guides for delineating the various lymph node levels, enabling consistent communication among healthcare professionals and accurate staging of diseases.

Level I: Submental and Submandibular Nodes

Level I is subdivided into two distinct regions: Level Ia (submental) and Level Ib (submandibular). These nodes are often the first to be affected by cancers originating in the oral cavity and surrounding structures.

Level Ia: Submental Nodes

The submental nodes are located in a median region between the anterior bellies of the digastric muscles. They drain lymph from the following areas:

• Floor of mouth
• Anterior tongue
• Lower lip
• Anterior mandibular alveolar ridge

Level Ib: Submandibular Nodes

Submandibular nodes are found in the space bounded by the inner aspect of the mandible laterally and the digastric muscle medially. This region extends from the symphysis menti anteriorly to the submandibular gland posteriorly. These nodes receive drainage from:

• Oral cavity
• Anterior nasal cavity
• Soft tissues of the mid-face
• Submandibular gland

Are Level I nodes always involved in oral cavity cancers? While Level I nodes are at high risk for metastases from oral cavity cancers, involvement can vary depending on the specific site and extent of the primary tumor. Careful clinical and radiological evaluation is necessary for accurate staging.

Level II: Upper Jugular Nodes

Level II encompasses the upper jugular chain of lymph nodes and is further divided into levels IIa and IIb. This region is a critical area for lymphatic drainage from various structures in the head and neck.

Level IIa: Anterior to the Spinal Accessory Nerve

Level IIa nodes are located anterior to the spinal accessory nerve and receive lymphatic drainage from:

• Oral cavity
• Nasal cavity
• Nasopharynx
• Oropharynx
• Hypopharynx
• Larynx
• Parotid gland

Level IIb: Posterior to the Spinal Accessory Nerve

Level IIb nodes are positioned posterior to the spinal accessory nerve and are more commonly associated with:

• Nasopharyngeal cancers
• Oropharyngeal cancers

Why is the distinction between Level IIa and IIb important? The differentiation between these sublevels is crucial for surgical planning and radiation therapy. Level IIb dissection carries a higher risk of injury to the spinal accessory nerve, which can lead to shoulder dysfunction. Therefore, understanding the likelihood of involvement based on the primary tumor site can guide treatment decisions and potentially reduce morbidity.

Level III: Mid Jugular Nodes

Level III comprises the mid jugular chain of lymph nodes, which play a significant role in the drainage of various head and neck structures. This level is bounded superiorly by the hyoid bone and inferiorly by the inferior border of the cricoid cartilage.

Drainage Patterns and Associated Primary Sites

Level III nodes receive efferent lymphatics from:

• Level II nodes
• Level V nodes
• Retropharyngeal nodes
• Pretracheal nodes
• Recurrent laryngeal nodes

Additionally, Level III collects lymphatics directly from:

• Base of the tongue
• Tonsils
• Larynx
• Hypopharynx
• Thyroid gland

Which cancers are most likely to metastasize to Level III nodes? Level III nodes are at significant risk of harboring metastases from cancers of the oral cavity, nasopharynx, oropharynx, hypopharynx, and larynx. The involvement of these nodes often indicates a more advanced stage of disease and may influence treatment decisions and prognosis.

Level IV: Lower Jugular and Medial Supraclavicular Nodes

Level IV is divided into two sublevels: IVa and IVb. This division is based on the anatomical location and the risk of involvement by different primary tumors.

Level IVa: Upper Lower Jugular Nodes

Level IVa extends from the inferior border of the cricoid cartilage to approximately 2 cm cranial to the sternoclavicular joint. These nodes are at risk for metastases from:

• Hypopharyngeal cancers
• Laryngeal cancers
• Thyroid cancers
• Cervical esophageal cancers

Level IVb: Lower Jugular and Medial Supraclavicular Nodes

Level IVb encompasses the region from 2 cm above the sternoclavicular joint to the clavicle. These nodes are particularly associated with metastases from:

• Hypopharyngeal cancers
• Subglottic laryngeal cancers
• Tracheal cancers
• Thyroid cancers
• Cervical esophageal cancers

Can Level IV nodes be involved in oral cavity cancers? While less common, it is possible for anterior oral cavity cancers to metastasize to Level IV nodes with minimal or no involvement of more proximal nodes. This phenomenon, known as “skip metastasis,” underscores the importance of thorough evaluation of all nodal levels, even in seemingly early-stage oral cavity cancers.

Level V: Posterior Triangle and Supraclavicular Nodes

Level V includes the lymph nodes of the posterior triangle group, located posterior to the sternocleidomastoid muscle. This level is further subdivided into Va and Vb, each associated with different primary tumor sites and drainage patterns.

Level Va: Upper Posterior Triangle Nodes

Level Va encompasses the upper portion of the posterior triangle, extending from the base of the skull to the inferior border of the cricoid cartilage. These nodes are at risk for metastases from:

• Nasopharyngeal cancers
• Oropharyngeal cancers
• Cutaneous malignancies of the posterior scalp and neck

Level Vb: Lower Posterior Triangle and Supraclavicular Nodes

Level Vb includes the lower portion of the posterior triangle and the supraclavicular region. These nodes are more commonly involved in:

• Thyroid cancers
• Esophageal cancers
• Lung cancers (as part of distant metastases)

Why is the distinction between Level Va and Vb clinically relevant? The differentiation between these sublevels is important for both diagnostic and therapeutic purposes. Level Va nodes are more likely to be involved in head and neck cancers, while Level Vb involvement may indicate either advanced regional disease or metastases from infraclavicular primary tumors. This distinction can significantly impact staging, treatment planning, and prognosis.

Imaging Techniques for Cervical Lymph Node Assessment

Accurate imaging of cervical lymph nodes is crucial for staging head and neck cancers, planning treatment, and monitoring response to therapy. Several imaging modalities play important roles in this assessment.

Computed Tomography (CT)

CT is widely used for evaluating cervical lymph nodes due to its availability, speed, and ability to provide detailed anatomical information. Key features of CT in lymph node assessment include:

• Size measurement
• Shape evaluation
• Presence of necrosis or extracapsular spread
• Relationship to surrounding structures

How does CT help in delineating cervical lymph node levels? CT provides excellent spatial resolution and allows for precise localization of lymph nodes in relation to key anatomical landmarks. Axial, coronal, and sagittal reconstructions can be used to accurately assign nodes to specific levels, facilitating communication between radiologists and clinicians.

Magnetic Resonance Imaging (MRI)

MRI offers superior soft tissue contrast compared to CT and can provide additional information about lymph node characteristics. Benefits of MRI include:

• Better differentiation between benign and malignant nodes
• Improved detection of necrosis and extracapsular spread
• No ionizing radiation exposure
• Potential for functional imaging (e.g., diffusion-weighted imaging)

Ultrasound

Ultrasound is a valuable tool for real-time evaluation of cervical lymph nodes and can guide fine-needle aspiration biopsies. Advantages of ultrasound include:

• High spatial resolution for superficial structures
• Assessment of internal architecture and vascularity
• No radiation exposure
• Cost-effectiveness

Positron Emission Tomography (PET)

PET, typically combined with CT (PET/CT), provides functional information about lymph nodes based on their metabolic activity. PET is particularly useful for:

• Detecting occult metastases
• Assessing treatment response
• Identifying recurrent disease

Which imaging modality is best for cervical lymph node evaluation? The choice of imaging modality depends on various factors, including the clinical scenario, availability, and specific information needed. Often, a combination of techniques is used to provide comprehensive assessment. CT and MRI are typically the primary modalities for initial staging, while ultrasound may be used for follow-up and biopsy guidance. PET/CT is increasingly utilized for both initial staging and post-treatment surveillance.

Clinical Significance of Cervical Lymph Node Levels

Understanding the patterns of lymphatic drainage and the significance of each cervical lymph node level is crucial for the management of head and neck cancers. This knowledge impacts various aspects of patient care, from diagnosis to treatment planning and prognosis.

Staging and Prognosis

The presence, location, and extent of lymph node involvement are key factors in the TNM staging system for head and neck cancers. The specific levels affected can provide important prognostic information:

• Involvement of lower levels (III, IV) often indicates more advanced disease
• Bilateral or contralateral node involvement may suggest a poorer prognosis
• The number of involved levels can impact overall survival rates

Treatment Planning

The pattern of lymph node involvement guides treatment decisions, including:

• Extent of surgical neck dissection
• Radiation therapy field design
• Selection of systemic therapy regimens

How does lymph node level involvement influence surgical approach? The specific levels involved may determine whether a selective, modified radical, or radical neck dissection is performed. For example, early-stage oral cavity cancers might only require dissection of levels I-III, while more extensive disease may necessitate a comprehensive approach including levels I-V.

Post-treatment Surveillance

Knowledge of lymph node levels is essential for post-treatment monitoring:

• Identifying areas at high risk for recurrence
• Distinguishing between expected post-treatment changes and true recurrence
• Guiding the focus of follow-up imaging studies

Research and Clinical Trials

The standardized nomenclature of cervical lymph node levels facilitates:

• Consistent reporting in clinical studies
• Comparison of outcomes across different institutions
• Development of evidence-based treatment guidelines

Why is a thorough understanding of cervical lymph node levels important for multidisciplinary cancer care? Comprehensive knowledge of lymph node levels enables effective communication among team members, including surgeons, radiation oncologists, medical oncologists, and radiologists. This shared understanding ensures coordinated care, optimizes treatment planning, and ultimately improves patient outcomes in the management of head and neck cancers.

The Radiology Assistant : Cervical Lymph Node Map

modified from Robbins

Aurelia Fairise and Robin Smithuis

Institut de Cancérologie de Lorraine in Nancy, France and the Alrijne hospital in Leiderdorp, the Netherlands

Publicationdate 2022-07-11

This article is based on the nomenclature proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery.

10 node groups are defined with a concise description of their main anatomic boundaries, the normal structures juxtaposed to these nodes, and the main tumor sites at risk for harboring metastases in those levels [1]. 

Overview

In this cervical lymph node map the levels were extended to 10.

Some of these are being divided into sub-levels to correspond more completely with the TNM atlas.

Borders

Important landmarks are:

• Hyoid bone
• Cricoid
• Carotids
• Sternocleidomastoid muscle
• Manubrium of sternum

Axial CT

Axial CT slices in correlation to overview illustration.

Axial CT slices in more detail.
Enlarge images by clicking on them.

Levels

I – Submental and submandibular

Nodes in level I are at risk of developing metastases from cancers of the oral cavity, anterior nasal cavity and the soft tissues of the mid-face and the submandibular gland.

Level Ia 
is a median region located between the anterior belly of the digastric muscles, which contains the submental nodes.

Level Ib 
contains the submandibular nodes located in the space between the inner side of the mandible laterally and the digastric muscle medially, from the symphysis menti anteriorly to the submandibular gland posteriorly.

II – Upper jugular

Level II receives lymphatics from the face, the parotid gland, and the submandibular, submental and retropharyngeal nodes.
Level II also directly receives the collecting lymphatics from the nasal cavity, the pharynx, the larynx, the external auditory canal, the middle ear, and the sublingual and submandibular glands [1]. 

Level II can be divided into level IIa and level IIb by drawing a line at the posterior edge of the internal jugular vein.

The nodes in level IIa and IIb are at risk of harboring metastases from cancers of the nasal and oral cavity, nasopharynx, oropharynx, hypopharynx, larynx and major salivary glands.

Level IIb is more likely associated with primary tumors of the oropharynx or nasopharynx, and less frequently with tumors of the oral cavity, larynx or hypopharynx [1].

III – Mid jugular

Level III receives efferent lymphatics from levels II and V, and some efferent lymphatics from the retropharyngeal, pretracheal and recurrent laryngeal nodes.
It collects the lymphatics from the base of the tongue, tonsils, larynx, hypopharynx and thyroid gland.

The inferior border of the cricoid is the border between level III and IVA.

Nodes in level III are at risk of harboring metastases from cancers of the oral cavity, nasopharynx, oropharynx, hypopharynx and larynx.

IV – Lower jugular and medial supraclavicular

The border between level IVa and IVb is set arbitrarily 2 cm cranial to the sterno-clavicular joint.

Level IVa
These nodes are at risk for harboring metastases from cancers of the hypopharynx, larynx, thyroid and cervical esophagus.
Rarely metastases from the anterior oral cavity may manifest in this location with minimal or no proximal nodal disease.

Level IVb
These nodes are at risk for harboring metastases from cancers of the hypopharynx, subglottic larynx, trachea, thyroid and cervical esophagus.

V – Posterior triangle and Supraclavicular

Level V contains the nodes of the posterior triangle group located posteriorly to the sternocleidomastoid muscle around the lower part of the spinal accessory nerve and the transverse cervical vessels.

Nodes in level V are most often associated with primary cancers of the nasopharynx, the oropharynx, the cutaneous structures of the posterior scalp, and the thyroid gland.

Level Vc – Supraclavicular

This level contains the lateral supraclavicular nodes located in the continuation of the posterior triangle nodes (level Va and Vb) from the cervical transverse vessels down to a limit set arbitrarily 2 cm cranial to the sternal manubrium.
It corresponds partly to the area known as the supraclavicular fossa.

Level Vc receives efferent lymphatics from the posterior triangle nodes (level Va and Vb) and is more commonly associated with nasopharyngeal tumors [1]. 

Transverse cervical artery
Scroll through the images for the anatomy of the transverse cervical artery.

VI – Anterior cervical

This level contains the superficial anterior jugular nodes (level VIa) and the deeper prelaryngeal, pretracheal, paratracheal and recurrent laryngeal nerve nodes (level VIb).

Level VIa
This level contains the superficially located anterior jugular nodes.

Level VIb
This level is contained between the medial borders of the common carotid arteries.
The nodes in this area are:

• pre-laryngeal nodes in front of the larynx and cricoid
• pre-tracheal nodes in front of the trachea 
• paratracheal nodes also called recurrent laryngeal nerve nodes

Delphian lymph node

The Delphian lymph node derived its name from the oracle of Delphi, whose prophecy would be a death secondary to laryngeal cancer.

It is a pretracheal node in level VIa located anterior to the cricoid and in between the cricothyroid muscles.

The recurrent laryngeal nerves branch off the vagus, the left at the aortic arch, and the right at the right subclavian artery.

The left laryngeal nerve can be compressed by subaortic lymph node metastases in the aorto-pulmonary window as seen in patients with lung cancer.

VII – Retropharyngeal and retrostyloid

Retropharyngeal nodes receive lymphatics from the mucosa of the nasopharynx, the Eustachian tube and the soft palate. 

These nodes are at risk of harboring metastases from cancers of the nasopharynx, the posterior pharyngeal wall and the oropharynx (mainly the tonsillar fossa and the soft palate).

Level VIIa – retropharyngeal

These nodes lie within the retropharyngeal space, extending cranially from the upper edge of the first cervical vertebrae (massa lateralis) to the cranial edge of the body of the hyoid bone caudally (figure).

This space is bounded anteriorly by the pharyngeal constrictor muscles and posteriorly by the longus capitis and longus colli muscles.
Laterally, the retropharyngeal nodes are limited by the medial edge of the internal carotid artery.

Retropharyngeal nodes receive efferent lymphatics from the mucosa of the nasopharynx, the Eustachian tube and the soft palate.
These nodes are at risk of harboring metastases from cancers of the nasopharynx, the posterior pharyngeal wall and the oropharynx (mainly the tonsillar fossa and the soft palate).

Level VIIb – retrostyloid

The retro-styloid nodes are the cranial continuation of the level II nodes.
They are located in the fatty space around the jugulo-carotid vessels up to the base of skull at the jugular foramen. 

Click to enlarge

The retro-styloid space is delineated by the internal carotid artery medially, by the styloid process and the deep parotid lobe laterally, by the vertebral body of C1 and the base of skull posteriorly and by the pre-styloid para-pharyngeal space anteriorly.

VIII – Parotid

This level contains the parotid node group, which includes the subcutaneous pre-auricular nodes, the superficial and deep intraparotid nodes and the subparotid nodes. 

These nodes extend from the zygomatic arch and the external auditory canal down to the mandible.

They extend from the subcutaneous tissue laterally to the styloid process medially, and from the posterior edge of the masseter and the pterygoid muscles anteriorly to the anterior edge of the sternocleidomastoid muscle and the posterior belly of the digastric muscle posteriorly [1].

Click to enlarge

The parotid group receive lymphatic from the frontal and temporal skin, the eyelids, the conjunctiva, the auricle, the external acoustic meatus, the tympanum, the nasal cavities, the root of the nose, the nasopharynx, and the Eustachian tube.  

They are at risk of harboring metastases from cancers of the frontal and temporal skin, orbit, external auditory canal, nasal cavities and parotid gland.

IX – Buccofacial

Level IX contains the malar and bucco-facial node group, which includes inconsistent superficial lymph nodes around the facial vessels on the external surface of the buccinator muscle.
These nodes extend from the caudal edge of the orbit (cranially) down to the caudal edge of the mandible (caudally) where they reached level Ib. 

They lay on the buccinators muscle (medially) in the sub-cutaneous tissue, from the anterior edge of the masseter muscle and the Bichat’s fat pad (posteriorly) to the anterior sub-cutaneous tissue of the face.

The bucco-facial nodes receive efferent vessels from the nose, the eyelids, and the cheek. 

They are at risk of harboring metastases from cancers of the skin of the face, the nose, the maxillary sinus (infiltrating the soft tissue of the cheek) and the buccal mucosa.

X – Retroauricular and occipital

Level Xa contains the retroauricular (also called mastoid) and subauricular nodes, which includes superficial nodes lying on the mastoid process from the cranial edge of the external auditory canal cranially to the tip of the mastoid caudally. 

Level Xb contains the occipital lymph nodes, which are the cranial and superficial continuation of the level Va nodes up to the cranial protuberance. They lie from the posterior edge of the sternocleidomastoid muscle to the anterior (lateral) edge of the trapezius muscle.

Lymph node metastases in level X are from skin cancers of the retro-auricular area (Xa) and skin cancers of the occipital area (Xb).

Click on the image below to get more information about Medical Action Myanmar, a medical organization run by Nini Tun and Frank Smithuis, who happens to be the brother of Robin Smithuis.

1. Delineation of the neck node levels for head and neck tumors: A 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines

   DAHANCA, EORTC, HKNPCSG,NCIC CTG, NCRI, RTOG, TROG consensus guidelines.
   by V Grégoire et al.
   Radiother Oncol 2014 ;110:172–81.

2. Integrating radiological criteria into the classification of cervical lymph node disease.
   by Robbins KT.
   Arch Otolaryngol Head Neck Surg 1999 ;125:385–7.

3. International association for the study of lung cancer (IASLC) lymph node map: radiologic review with CT illustration.

   by El-Sherief AH, Lau CT, Wu CC, Drake RL, Abbott GF, Rice TW.
   Radiographics. 2014 Oct;34(6):1680-91.

Head and neck cancer | Macmillan Cancer Support

Head and neck cancer is a general term to describe different cancers in this area. These cancers start in the tissues in the head and neck area. For example, in the:

• mouth which includes the tongue, palate, gums and lips
• throat (the pharynx) which is divided into the nasopharynx, oropharynx and hypopharynx
• nose and sinuses (air-filled spaces in the bones of the face)
• salivary glands which make saliva
• middle ear which contains the ear drum.

Image: Cross-section of the head and neck

About 12,200 people are diagnosed with head and neck cancer in the UK every year. This includes cancer of the larynx (voicebox). In the UK, head and neck cancer is the 4th most common cancer in men.

We have separate information about cancer of the larynx.

To make sure you have the right information, it is important to know the type of head and neck cancer you have. If you are not sure, ask your cancer doctor or specialist nurse.

Other types of cancer can start in the head and neck area, but they are not head and neck cancers. We have separate information on these. They include cancers that start in the thyroid, oesophagus (gullet), windpipe (trachea) and brain.

Booklets and resources

Understanding head and neck cancer

A booklet explaining cancer of the head and neck, covering the causes and symptoms, diagnosis, staging and…

Understanding head and neck cancers

This audiobook is about head and neck cancers, including cancers of the mouth and throat, as well as rarer. ..

Head and neck cancers are named after where they start – the area of the head or neck, and the type of cell. The most common type of head and neck cancer is squamous cell carcinoma. About 9 out of 10 head and neck cancers (90%) start in squamous cells. Squamous cells line the surfaces inside the head and neck, such as the mouth, nose and throat.

The most common place for head and neck cancer to spread to is the lymph nodes in the neck. This may cause a swollen lymph node in the neck. Lymph nodes are part of the lymphatic system which helps protect us from infection and disease.

Image: Lymph nodes in the head and neck 

• Mouth cancer is one of the most common areas for head and neck cancer to start. It can start anywhere in the mouth, such as on the lip, inside the cheek, the gums, the front part of the tongue, or on the floor or roof of the mouth.

• The tongue has 2 parts and cancer can develop in either of them. If cancer develops in the front part, which is the area you can see, it is usually called mouth cancer. We have more information about tongue cancer.

  The back part is the base of the tongue close to the throat (pharynx). Cancer that develops in this part of the tongue is called oropharyngeal cancer.

• Nasopharyngeal cancer starts in the upper throat (pharynx) area behind the nose. This area is called the nasopharynx. The nasopharynx allows air to flow from the nose, through the rest of the throat and into the lungs. Often the first symptom of nasopharyngeal cancer is a painless swelling or lump in the upper neck.

• Oropharyngeal cancers start in the middle pharynx, behind the mouth. This area is called the oropharynx. The oropharynx is a passageway for air and the food you swallow. It has muscles that help move food from the mouth to the gullet (oesophagus).

  It includes the:

  • soft part of the roof of the mouth (soft palate)
  • the base or back of the tongue (the part you cannot see)
  • tonsils and the side walls of the throat.

  Oropharyngeal cancers usually develop on the tonsils or the base of the tongue.

• These cancers start in the lower part of the pharynx, behind the voice box (larynx). This area is called the hypopharynx. It has muscles that move food into the gullet (oesophagus), which it connects to. Air passes along the hypopharynx into the airways to the lung. Cancer of the hypopharynx may be treated in the same way as laryngeal cancer.

• The larynx is the voice box. It is a short passageway in front of the hypopharynx. It contains the vocal cords. We have separate information about laryngeal cancer and its treatment.

• The space inside the nose is called the nasal cavity. The bones around the nasal cavity have small hollow spaces called paranasal sinuses. These sinuses affect the sound and tone of your voice. The most common symptoms of nasal and sinus cancer include a blocked nose that does not go away (usually only on 1 side) and nosebleeds.

• The salivary glands make saliva (spit). The biggest pairs of salivary glands are the parotid glands at the sides of the mouth, just in front of the ears. This is the most common place for salivary gland cancer to develop. Tumours that develop in the salivary glands can be non-cancerous (benign) but some are cancer.

• Rarely, cancer can develop in the middle ear. The middle ear is made up of the eardrum and a cavity called the tympanum. The tympanum contains 3 small bones, which connect the eardrum to the inner ear. It is also connected to the nasopharynx by the eustachian tube.

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  What is cancer?
  

The symptoms depend on where the cancer started in the head or neck. With certain symptoms, you may see a specialist within 2 weeks (called an urgent referral).

Some of these symptoms include having:

• an ulcer in the mouth for more than 3 weeks
• red or white patches in the mouth.

Others are symptoms that do not go away, such as:

• a lump in the neck, on the lip or inside the mouth
• a sore tongue
• a sore throat
• hoarseness
• problems swallowing.

We have more information about the signs and symptoms of head and neck cancer.

Related pages

• 
  
  
  Do I have cancer?
  

The main risk factors for head and neck cancer are tobacco and alcohol, especially when combined. Head and neck cancer is also much more common in men than in women.

Certain risk factors depend on the type of head and neck cancer you have. Many cancers of the oropharynx are linked to an infection with a virus called human papilloma virus (HPV) is linked to the Epstein-Barr virus.

We have more information about the causes and risk factors for head and neck cancers.

If your GP or dentist think your symptoms could be linked to cancer, they will refer you to see a specialist doctor within 2 weeks. This is usually an oral and maxillofacial surgeon, or an ear, nose and throat (ENT) specialist surgeon.

Neck lump clinic

If your only symptom is a lump in your neck, you may be referred to a one-stop neck lump clinic. You can have all the tests needed to check for cancer in a neck lump. These may include:

• an ultrasound neck scan
• removing a sample of tissue from the lump (a biopsy)
• nasendoscopy – a test that looks at the back of your mouth, nose and throat.

You may get the results of your tests on the same day, or 7 to 10 days later.

At the hospital

Your specialist doctor will ask you about your symptoms and examine your mouth, throat and neck. They may take blood tests, to check your general health. If you have an abnormal-looking area that can be seen and is easy to reach, they may remove a small piece of tissue or some cells from the area (biopsy). This is checked for cancer cells.

Your doctor and specialist nurse will explain the tests you need. You may have a test using a thin flexible tube with a light and camera on the end (endoscope). Different types of endoscope can be used to examine the mouth, nose, throat and sometimes the gullet (oesophagus) area.

Some people have a general anaesthetic so the doctor can examine the area more closely using a bigger endoscope. This is sometimes called a panendoscopy.

You may have a biopsy on its own or during some of these tests.

We have more information about tests for head and neck cancer.

Further tests for head and neck cancer

If tests show you have a head and neck cancer, your specialist will arrange further tests. These can help find out more about the size and position of the cancer and whether it has spread. This is called staging. These tests could include:

• You may have an x-ray of your face or neck to see if any bones are affected by the cancer, and to check your teeth. You may have a chest x-ray to check your general health and to see if there is anything abnormal in the lungs.

• A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of your body.

• An MRI scan uses magnetism to build up a detailed picture of areas of your body.

• A PET-CT gives more detailed information about the part of the body being scanned.

Testing for viruses

If you have oropharyngeal cancer, tests are done on the cancer cells to check if it is linked to the human papilloma virus (HPV). The results help your doctor plan the most effective treatments for you. HPV-related head and neck cancers usually have a good outlook.

If you have nasopharyngeal cancer, the cancer cells are tested to see if it is linked to the Epstein-Barr virus (EBV).

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  Going for tests
  

The stage of a cancer describes its size and if it has spread from where it started.

Staging is slightly different for each type of head and neck cancer. Oropharyngeal cancer that are HPV-positive have a separate staging system.

A doctor decides the grade of the cancer by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer may develop.

Knowing the stage and grade of head and neck cancer helps you and your doctors decide on the best treatment for you.

Because head and neck cancer is not common, you are usually treated in a specialist head and neck unit. A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

They will also talk to you about preparing for treatment (sometimes called prehabilitation). This may include things like:

• stopping smoking or drinking to make your treatment more effective
• dental checks or dental treatment
• dietary advice to improve your weight
• certain exercises to reduce the risk of side effects.

We have more information about preparing for head and neck cancer treatment.  

The aim of treatment is to remove or destroy the cancer and reduce the risk of it coming back. Your treatment depends on:

• where the cancer is
• the type and stage of the cancer
• the best way to maintain appearance, speech and swallowing
• your general health
• your preferences.

Your doctor and nurse will explain the benefits and disadvantages of different treatments. They will also talk to you about things to consider when making treatment decisions before you agree (consent) to have treatment. You and your doctor can decide together on the best treatment for you.

Doctors plan your treatment so the effect on your appearance, speech, swallowing and eating is as little as possible. If treatment is likely to affect any of these, your doctor and nurse will talk to you about this. They will explain how long this is likely to last and how they can support you. You may see different specialists such as a dentist, speech or language therapist (SLT), or dietitian during treatment.

Treatment for head and neck cancers may include:

• Surgery is one of the main treatments for cancers of the head and neck. Small cancers may be treated with a simple operation or laser surgery. If the cancer is bigger, the surgeon may also remove the lymph nodes in the neck. Some people might need reconstructive surgery. This is when the surgeon takes tissue from another part of the body to replace tissue taken from the head and neck.

• Chemoradiation is when you have chemotherapy and radiotherapy together. It is often the main treatment for locally advanced head and neck cancer. The chemotherapy helps the radiotherapy to work better. It can also be given after surgery. Chemoradiation can cause severe side effects so it may not be suitable for everyone.

• Radiotherapy can be used on its own to treat small cancers or cancers in harder-to-reach areas. But is often given in combination with chemotherapy (called chemoradiation).

• You may have chemotherapy on its own before radiotherapy or surgery to shrink the cancer and make treatment work better. It is often given in combination with radiotherapy (chemoradiation). Sometimes chemotherapy can be used to control the symptoms of the cancer.

• The targeted therapy drug cetuximab is sometimes used if chemoradiation is not suitable for you.

  Pembrolizumab and nivolumab are immunotherapy drugs that may sometimes be used if the cancer is advanced or comes back.

Your treatment depends on the stage of the cancer.

• Small cancers that have not spread can usually be treated with surgery. If the operation causes any small changes to speech, chewing or swallowing, you can usually adapt to these quickly.

  Your doctors may suggest radiotherapy instead of surgery if the cancer is in a difficult-to-reach area. Or, if surgery may cause major changes to appearance, speech or swallowing.

• If the cancer is bigger, or has spread to lymph nodes in the neck, you usually need more than one type of treatment. Chemotherapy and radiotherapy are often used together (called chemoradiation). This may be your main treatment.

  If you have surgery to remove the cancer you may also have the lymph nodes in the neck removed. Some people may need reconstructive surgery. The aim is to cause as little change as possible to appearance and how things like swallowing or speech.

  After surgery some people have chemoradiation or radiotherapy to treat any remaining cancer cells. Chemotherapy on its own may also be used to shrink a cancer before radiotherapy or surgery. It can also be used to try to control the cancer and improve symptoms.

  A targeted therapy drug called cetuximab is sometimes given with radiotherapy if you cannot have chemoradiation. Sometimes immunotherapy drugs may be given on their own. This is usually if the cancer is advanced, or if it comes back after treatment.

• If the cancer cannot be cured, you may be given treatment to control the cancer for as long as possible, and to manage the symptoms. You will usually have chemotherapy, or targeted therapy or immunotherapy.

  Your doctor and specialist nurse will help to make sure your symptoms are controlled. This is called supportive or palliative care. You may see a specialist palliative care doctor or nurse for expert help with your symptoms.

You may have some treatments as part of a clinical trial.

Related pages

• 
  
  
  Your treatment options
  
• 
  
  
  Getting ready for treatment
  

After your treatment, you will have regular follow-up appointments for several years. Your specialist will regularly examine your head and neck. This is the most important part of your follow-up. You may sometimes have scans.

It can take several months for the side effects of the treatment to improve. Always tell your specialist about:

• ongoing side effects or symptoms that are not improving
• any new symptoms that do not get better within 2 weeks.

Your nurse can tell you what to look out for after treatment. For example, this might be a new ulcer or a lump in your neck, pain, or difficulty swallowing or speaking. Contact your doctor or nurse as soon as possible if you notice any symptoms or side effects. You do not need to wait until your next appointment.

Late effects

Treatment side effects may affect how you eat and drink, or your speech. These changes may return to normal, or near normal, as the area recovers from surgery or radiotherapy. Your speech and language therapist (SLT) and dietitian will assess you. They help you learn to cope with any changes.

Late effects are side effects that do not improve, or that develop years after treatment has finished. Your doctor or nurse will explain any likely late effects of your treatment. Not everyone gets late effects. It depends on the treatment you had.

We have more information about managing late effects of head and neck cancer treatments.

Sex life

Head and neck cancer and its treatment can sometimes have an effect on your sex life.

If you are worried about this, talk to your doctor or nurse. You can read about things that may help in our information on cancer and sex.

Fertility

Some cancer treatments can also affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

We have more information about:

• fertility in women after treatment
• fertility in men after treatment.
• LGBTQ+ people and cancer treatment

Body image

If treatment has changed your appearance, voice or how you eat and drink it can also affect your body image. Talk to your nurse if this is a concern for you. There are different things that can help to improve body image changes. There are also organisations below that can help to support you.

Well-being and recovery

Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes during and after treatment. For example, if you smoke or drink alcohol, it is best to avoid smoking or reduce the amount of alcohol.

Eating well and keeping active can improve your health and well-being. It can also help your body recover. Your dietitian can help with any difficulties you might have with eating after treatment.

Getting support

It may take several months to recover from treatment. It can be hard if treatment has changed your appearance, how you eat or drink, or your voice. This may also affect your body image but there are ways to help you to manage any changes.

You may still be coping with difficult feelings. Talking to your family and friends or health professionals about how you feel can help them know how to support your well-being.

There are also national support groups that you may find helpful:

• The Mouth Cancer Foundation
  
  The Mouth Cancer Foundation gives information and support to people affected by head and neck cancers.
• Changing Faces
  
  Changing Faces offers advice and information to anyone who is affected by a change in their appearance.
• The Swallows Head and Neck Cancer Support Group
  
  The Swallows offers a 24-hour support line to anyone affected by head and neck cancer.

Macmillan is also here to support you. If you would like to talk, you can:

• Call the Macmillan Support Line on 0808 808 00 00.
• Chat to our specialists online.
• Visit our head and neck cancer forum to talk with people who have been affected by head and neck cancer, share your experience, and ask an expert your questions.

Related pages

• 
  
  
  Finishing treatment
  

We are committed to making our website as accessible as possible, to make sure that everyone can use it.

For braille and large print on request, please email [email protected].

Explore our alternative formats

Find accessible cancer information in a format that works for you.

• Below is a sample of the sources used in our head and neck cancer information. If you would like more information about the sources we use, please contact us at [email protected]

  Machiels J.-P, Leemans C. R. et al. Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx. EHNS- ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 2020. Volume 31, Issue 11, Pages 1462-1475.

  National Institute for Health and Care Excellence (NICE). Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over. NICE guideline NG36 2016 (updated 2018). 

• This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Chris Alcock, Consultant Clinical Oncologist.

  Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

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Macmillan Support Line

The Macmillan Support Line is a free and confidential phone service for people living and affected by cancer. If you need to talk, we’ll listen. 

Call us on 0808 808 00 00

8am to 8pm. It’s free to call from landlines and mobiles within the UK.

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Ultrasound examination of the lymph nodes – health articles

Ultrasound of the lymph nodes is a popular non-invasive method for diagnosing numerous pathologies of the lymphatic system. The examination is safe and informative. If it is carried out using expert-class equipment, it allows you to get accurate results in a short time.

Functions of the lymph nodes

Organs are a natural barrier to pathological bacteria and other harmful substances and reliably protect the body, providing blood purification, acting as special filters. In them, the intercellular fluid is cleared of infections and toxins. In addition, the lymph is saturated with immune cells. Already purified, it enters the general bloodstream, where it delivers the necessary nutrients.

Such barriers are distributed throughout the body.

There are hundreds of nodes in the system, which are divided into the following groups:

• ear
• occipital
• chin pads
• mandibular
• anterior and posterior cervical
• axillary
• chest
• abdominal and retroperitoneal
• inguinal
• popliteal

Important! Lymph nodes are a vulnerable organ. The way they perform their functions largely depends on the state of immunity. Organs react sharply to any pathological processes.

If the body works without failures, then with simple palpation, the lymph nodes are practically not palpable. They are not enlarged and do not cause any discomfort to a person. Changes occur when there are violations in the work of individual organs and entire systems. In such situations, the lymph nodes can greatly increase in size, become a source of severe discomfort and even pain.

As a rule, changes in organs are accompanied by:

• viral infections
• connective tissue deformities
• oncological pathologies
• allergic reactions

As a rule, those lymph nodes that are located in the immediate vicinity of the focus of the pathological process increase and become inflamed. Thanks to this feature, doctors are able to quickly diagnose and prescribe the necessary treatment for the identified disease. For accurate diagnosis, an ultrasound examination is performed.

Essence of ultrasound

This method is based on the fact that body tissues are capable of transmitting ultrasonic waves. Healthy lymph nodes are not displayed on the device monitor. You can visualize them only if there are changes. If any pathology is suspected, the doctor evaluates such basic parameters of the organs as:

• width and length
• form
• structure features

A comprehensive assessment of the main parameters allows drawing conclusions about the lesions of the lymphatic system, identifying the cause of the pathological condition and preventing possible complications.

As part of the diagnostics, you can find:

• Bacterial infections: chlamydia, syphilis, otitis, bronchitis, brucellosis, tuberculosis, etc.
• Viral infections: rubella, measles, hepatitis, HIV and AIDS, mononucleosis, etc.
• Malignant tumors and their metastases: leukemia, thyroid and breast cancer, neuroblastoma, lymphoma, etc.
• Immunodeficiency and autoimmune diseases: systemic lupus erythematosus, rheumatoid arthritis, chronic granulomatous disease, etc.
• Other diseases: sarcoidosis, Kawasaki disease, Castleman disease, Niemann-Pick disease, Gaucher disease, etc.

It is possible to make an ultrasound of the lymph nodes in order to control when taking certain medications, as part of a general diagnosis, at the stage of pregnancy planning.

The accuracy of the method depends on the location of the organs, the quality of the apparatus used and the experience of the doctor. The most accurate results are if the examination area is close to the skin surface. To make an ultrasound of the lymph nodes of the neck, for example, is quite simple. Less accurate assessment will have the study of intraperitoneal and intrathoracic organs.

Diagnostic indications

Ultrasound of the lymph nodes should be done both at the stage of diagnosis and as part of clarifying and control examinations that are performed during therapy.

The main indications for research include:

• chronic colds
• thyroid pathology
• suspected cysts and tumors
• abscesses

You should consult a doctor as soon as possible in case of any pathological changes in the organs.

These include:

• causeless inflammation and enlarged nodes
• occurrence of discomfort and pain
• tissue sealing
• asymmetry and mobility

There are also indications for specific local studies.

Ultrasound of the cervical and head lymph nodes, for example, is performed when:

• gum bleeding and overgrowth
• jaw and facial deformities
• chronic ear, nose and throat infections
• acute infectious and inflammatory processes, which are characterized by a runny nose and cough, pain in the mouth, difficulty swallowing
• suspected leprosy, tuberculosis and syphilis
• the presence of tumors of the larynx, throat, tongue, thyroid gland, etc.

An examination of the axillary and ulnar groups of organs is prescribed for:

• suspected tumors of the chest and mammary glands
• the need to monitor the progress of rehabilitation after breast removal interventions
• signs of malignant tumors in various organs
• suspected HIV infection

Diagnostics of the nodes of the lower extremities (popliteal and inguinal) is carried out with:

• suspected sexually transmitted infections
• inflammatory diseases of the pelvic organs and urinary system
• HIV infections
• inflammatory or infectious processes that are localized on the lower limb
• suspected tumor

Important! The direction for the study is issued by the doctor. He also determines which ultrasound of the lymph nodes (neck, inguinal, axillary region, etc.) is required.

Contraindications

The main contraindications include:

• severe skin lesions in the affected area
• open wounds
• detection in the body of syphilides, Koch’s bacillus, lepromatous cells

Important! Examination for pregnant women is prescribed with caution.

Ultrasound types

Currently, the following groups of organs are being examined:

1. Peripheral. They are located in the subcutaneous tissue of the mammary glands, as well as in the neck, head and limbs. These include parotid, mental, occipital, sub- and supraclavicular, anterior and posterior cervical, as well as mandibular lymph nodes, inguinal, popliteal, ulnar and axillary cavities
2. Intraperitoneal. They are located in the area of ​​the spleen, hilum of the liver, mesentery (folds inside two layers of peritoneum) of the intestine
3. Retroperitoneal (renal). They are in the abdominal cavity but not covered by the peritoneum
4. Small pelvis. They are located in the area of ​​the urinary and genital organs
5. Mediastenal. Such nodes are located in the chest area

Important! Usually, a study of the state of a particular group is assigned, and not the entire system. For diagnosis, the group that is closest to the affected organ is selected. Ultrasound of several lymph nodes is performed if the course of the disease is severe and it is necessary to identify all the features of the pathology. Very rarely there are cases when a comprehensive examination is carried out. The decision on its implementation, as a rule, is made by a council of doctors.

Advantages of lymph node ultrasound at MEDSI in Moscow

• Experienced specialists. Doctors of ultrasound diagnostics carry out a thorough analysis of the examined organs, which allows revealing hidden pathological changes
• Modern equipment. We use expert class ultrasound machines. Equipment VIVID 7 and PHILIPS IU22, IE33 with a set of sensors for all diagnostic options allows you to detect early functional disorders and conduct clarifying studies
• No queues and the ability to sign up for the study at a convenient time. The interpretation of the results is also not delayed
• Possibility of examination of adults and children. We accept patients of different ages and provide comfortable conditions for everyone
• Possibility of carrying out functional and laboratory diagnostics of various types. In the clinic, you can undergo a comprehensive examination. It will allow you to quickly make a diagnosis and start therapy
• Possibility of treatment immediately after receiving the results. We are ready to carry out complex therapy of pathologies. If necessary, hospitalization of the patient is provided

If you want to undergo an ultrasound of the lymph nodes in Moscow in one of our clinics, to clarify the price of diagnostics, call +7 (495) 7-800-500. The specialist will answer all questions and select the optimal time for the examination.

Do not delay treatment, see a doctor right now:

CT scan of the neck lymph nodes that shows

Computed tomography is a modern non-invasive method of multilayer imaging of tissues and organs.

The method is used in the diagnosis of inflammatory, degenerative, oncological pathologies, used to assess traumatic injuries. CT scan of the lymph nodes of the neck makes it possible to study in detail the morphological and structural features of organs, identify structural changes, and determine the nature of the disease.

Scanning is carried out using x-rays. Body tissues are able to absorb ionizing radiation with different intensity. Radiopacity depends on the density of the studied structures. During computed tomography, special detectors record information about the throughput of a substance. The software is responsible for analyzing and converting the data into layered black-and-white images of transverse sections of the neck.

Multi-spiral devices are used to increase the scanning speed. Multislice devices consist of a conveyor and an annular part, inside which X-ray tubes and sensors are placed. When moving the table with the patient, the emitters simultaneously make circular movements, providing continuous scanning of the neck in a spiral. When conducting multislice computed tomography (MSCT), 2 or more photos are obtained in one full rotation of the gantry.

CT of the lymph nodes of the neck that shows how

Computed tomography makes it possible to examine tissues in layers. The thickness of the scanned section is controlled using a collimated x-ray beam. The minimum step starts from 0.1 cm, which allows you to see the affected areas with sizes from 3 mm.

On the basis of axial images complete the sagittal and frontal planes. To clarify the relative position of the anatomical structures, the doctor reconstructs a three-dimensional image of the area of ​​interest.

CT scan of neck lymph nodes is done as part of a soft tissue examination. To increase the information content, a bolus boost must be used. The essence of the procedure is the use of an iodine-based radiopaque solution. The drug is administered intravenously, using a catheter connected to a bolus device. As the coloring substance fills the lumen of the vessels, white areas appear on the tomograms, corresponding to the pattern of the circulatory network in the neck. The degree of vascularization of anatomical structures is determined by the nature of contrasting, the shape and size of neoplasms are specified.

Lymphadenopathy on CT: the arrow indicates an enlarged node

Malignant tumors are characterized by an extensive vascular system with a large number of anastomoses. A distinctive feature of malignant volumetric formations is the intensive accumulation and slow release of contrast.

CT scan of soft tissues and lymph nodes of the neck and will show:

• muscles and fatty tissue;

• thyroid gland;

• upper esophagus and trachea;

• parathyroid glands;

• larynx;

• salivary glands;

• lymph nodes.

The latter are classified according to location. There are 7 main groups of cervical lymph nodes:

Classification by groups and levels helps to solve many problems that arise during the planning of surgical treatment or radiation therapy.

CT soft tissues and cervical lymph nodes shows the shape, size, structure of organs, allows you to assess the condition of the fiber. Based on specific signs, the nature of the pathological process is determined, the reactive enlargement of the organ is differentiated from inflammatory, infectious lesions, malignant degeneration of tissues.

What diseases can be detected by CT scan of the lymph nodes of the neck

Computed tomography of soft tissues with contrast enhancement is used as a first-line diagnostic method. Scanning allows you to identify pathologies of the lymph nodes caused by a direct lesion of the latter, to visualize diseases of other organs and systems.

Negative changes can be caused by the immune system’s response to the presence of harmful microorganisms and other damaging factors. Lymph nodes are biological filters and are involved in the formation of protective reactions of the body. An increase in size, a change in the shape and structure of organs may be the result of an inflammatory, neoplastic or other pathological process in the body.

CT is used to diagnose:

Pathological processes in the head and neck area lead to an increase in regional nodes. Local lymphadenopathy is a symptom of the following diseases:

An increase in the size of regional lymph nodes is associated with the barrier function of the latter.

Volumetric formation in the neck area on the left

In the case of an inflammatory lesion, the lack of treatment can lead to purulent fusion of tissues, the development of adenophlegmon, sepsis and other serious complications.

What symptoms may indicate the need for CT

The reason for the appointment of computed tomography of the soft tissues of the neck are signs of lymphadenopathy. Examination is carried out in case of:

• hyperemia and edema of the skin at the site of the projection of the nodes;

• increase in size, soreness of organs;

• changes in the shape of the lymph nodes, tuberosity, determined by palpation;

• increase the density of glandular tissue.

General (systemic) signs of the pathological process are:

• long-term maintenance of subfebrile body temperature;

• symptoms of intoxication;

• sudden weight loss;

• changes in blood and urine tests.

Scanning of the soft tissues of the neck with a mandatory assessment of the state of regional lymph nodes is carried out as part of a comprehensive diagnosis of infectious, purulent diseases, if metastasis of malignant tumors is suspected.

In the period of preparation for surgery, CT allows you to assess the degree of tissue damage, clarify the size and location of the focus. In the rehabilitation period, CT helps to control recovery, timely detect relapses, and diagnose the development of complications.

Cervical lymph node metastases (marked with arrows)

In the treatment of oncological diseases through chemotherapy, scanning is prescribed to evaluate the effectiveness of medical manipulations. Elimination of the tumor with ionizing radiation is carried out after computed tomography. The study is used to draw up a treatment regimen.

CT of the cervical lymph nodes is done strictly according to the indications and in the presence of a referral from the attending physician. For children under the age of 12, due to the weak development of venous vessels, contrast scanning is performed in a hospital.

Computed tomography is one of the most informative diagnostic procedures. The unconditional advantages of the method include:

• the possibility of layer-by-layer study of tissues;

• high resolution images;

• the possibility of spatial visualization;

• speed and comfort of research;

• absence of traumatic manipulations.

Examination takes from 10 minutes. When using contrast enhancement, the duration of the session increases to half an hour.

The patient is positioned on the tomography table, special rollers are used to fix the body in the desired position. The doctor controls the course of the procedure through a transparent partition, if necessary, gives voice commands using a microphone. The subject can at any time signal the medical staff by pressing the panic button.

The disadvantage of computed tomography is the inevitable presence of radiation exposure. Compliance with sanitary and hygienic standards minimizes the negative effects of radiation and prevents the occurrence of side effects.

Ionizing rays are teratogenic, which limits the use of CT during pregnancy. The study is not carried out in the presence of serious X-ray-dependent pathologies.

Contraindications for contrasting are:

• allergic reaction to iodine;

• elevated levels of thyroid hormones in endocrine disorders;

• decompensated kidney disease;

• Use of Metformin in the treatment of diabetes mellitus.

Enhanced computed tomography requires special training. The patient takes a biochemical blood test. An elevated creatinine content in the latter indicates renal failure and is the reason for postponing the date of the examination or selecting an alternative scanning method.

Patients with diabetes should consult an endocrinologist. The drug should be discontinued no later than 2 days before the diagnostic procedure.

With strict observance of safety rules and competent preparation, computed tomography does not have a negative impact on the patient’s body.

CT scan interpretation of neck lymph nodes

Computed tomography results are interpreted by a radiologist. The study protocol includes information about the morphological and structural parameters of the scanned area.

In the description indicate:

• location and size of lymph nodes in the neck;

• condition of surrounding soft tissues;

• knot shape;

• presence of pathological inclusions;

• the nature of the accumulation and release of the contrast agent.

If pathological changes are detected, the doctor specifies the number, location and size of lesions.