What are the manifestations of nasopharyngeal carcinoma lymph node metastasis

The nasopharyngeal mucosa is extremely rich in lymphatic tissue, so nasopharyngeal carcinoma is very prone to cervical lymph node metastasis. About 1/3 of nasopharyngeal carcinoma patients seek medical treatment only after cervical lymph node metastasis occurs.

The main lymphatic vessels of the nasopharyngeal lymphatic tissue are concentrated in front or behind the side wall, flowing into the retropharyngeal lymph nodes beside the cervical spine, and then bypassing the back of the carotid artery to enter the deep cervical lymph nodes. The deep cervical lymph nodes can be divided into two groups: one group is behind the mandibular angle to the upper part of the sternocleidomastoid muscle; the other group is deep to the sternocleidomastoid muscle and below the mastoid tip (the hard bone protrusion behind the ear is the mastoid). The latter group is the most common lymph node metastasis of nasopharyngeal carcinoma.

In the early stages of nasopharyngeal carcinoma, cancer cells can metastasize through lymphatic vessels and present the following symptoms:

① First, the lymph nodes on the posterior pharyngeal wall swell, and then the deep lymph nodes in the back of the neck also swell.

② Painless nodules appear below the mastoid process or at the front edge of the upper sternocleidomastoid muscle.

③First, the lymph nodes on the affected side of the neck swell, then the lymph nodes on both sides of the neck swell, and eventually a huge lump will appear in the neck.

④ The tumor compresses the glossopharyngeal nerve (Ⅸ), causing swallowing difficulties.

⑤ The tumor compresses the vagus nerve (X), causing dysphonia

⑥ The tumor compresses the accessory nerve (Ⅺ), causing weakness in the ipsilateral shoulder.

⑦ If the tumor compresses the hypoglossal nerve (Ⅻ), the tongue muscles on one side will atrophy, the tongue will tend to the affected side when extended, and speech will be slurred.

⑧Patients may also experience vocal cord paralysis resulting in hoarseness, tongue muscle paralysis, etc.