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RC 408 - Pathways for tumour spread

Wednesday, March 1, 16:00 - 17:30 Room: N Session Type: Refresher Course Topics: Oncologic Imaging, Head and Neck Moderator: J. Huyskens (Antwerp/BE) Add session to my schedule In your schedule (remove)


A. Pathways for oral cavity and oropharynx tumour spread

A. Borges; Lisbon/PT

Learning Objectives

1. To become familiar with the anatomy of the oral cavity and oropharynx.
2. To learn which imaging technique to use.
3. To understand the typical local and remote spread of oral cavity and oropharynx tumours.


90% of oral cavity and oropharyngeal malignancies originate from the epithelial lining and spread superficially along the mucosa, deeply into the submucosa, adjacent muscles and bone and along neighbouring cranial nerves used as elevator shafts for tumour spread. There are 8 tumour subsites in the oral cavity each with different patterns of spread and implications on patient’s management. Those with direct impact on tumour staging or surgical management are the midline raphe, extrinsic tongue muscles, bone and oropharyngeal spread. Tumours of the retromolar trigone have a complex pattern of spread as they sit on the crossroad between the oral cavity, masticator space and oropharynx. Whereas gingival tumours of the superior alveolar ridge can invade the maxilla and spread along the superior alveolar nerves and V2, tumours of the inferior alveolar ridge can invade the mandible, the inferior alveolar nerve and spread along V3. Invasion of the neurovascular tongue bundle prone tumours to spread along the lingual or hypoglossal nerves. There are 4 different oropharyngeal subsites. The palatine tonsil has the highest association with lymph node metastases. Local spread is through the palatoglossus muscle and transgression of the constrictor muscles and pterygomandibular raphe leads to tumour extent into the retromolar trigone and pterygoid plates. Tongue base tumours can spread anteriorly to the tongue root and floor of the mouth and posteriorly into the supraglottic larynx. Palatal tumours spread inferiorly into the palatine fossa, laterally into the parapharyngeal space and are prone to perineural spread along the greater and lesser palatine nerves.

A-105 16:30

B. Pathways for nasopharyngeal tumour spread including perineural spread

V. Chong; Singapore/SG

Learning Objectives

1. To become familiar with the anatomy of the nasopharynx.
2. To learn which imaging technique to use.
3. To understand the typical local and remote spread of nasopharyngeal tumours, including perineural spread.


Most nasopharyngeal carcinomas (NPC) originate in the fossa of Rosenmuller and spread along well-defined routes. Tumours often spread into the nasal and pterygopalatine fossa. From the nasal cavity tumours can infiltrate the pterygopalatine fossa which may lead to perineural infiltration of the maxillary nerve and further extend into the intracranial cavity. Tumours may infiltrate further into the orbital apex and enter the intracranial cavity through the superior orbital fissure. Lateral spread involves the parapharyngeal and masticator spaces. When tumour enters these spaces, there is a risk of perineural infiltration along the mandibular nerve. Perineural spread along the mandibular nerve is a frequent route of intracranial extension. When NPC spreads superiorly, it erodes the skull base with subsequent direct extension into the intracranial cavity. Lesions may also be seen to spread through the foramen lacerum. Cervical nodal metastasis is very common and up to 80% of patients have enlarged nodes at presentation. Nodal metastasis show an orderly inferior spread and the affected nodes are larger in the upper neck. Spread to the supraclavicular nodes has grave prognostic significance. Up to 50% of patients with supraclavicular lymphadenopathy will eventually have distant metastases. NPC shows a high frequency of distant metastasis compared with other tumours of the head and neck. The frequency of distant spread varies between 5% and 41%. Common sites of distant metastases include bone (20%), lung (13%) and liver (9%).

A-106 17:00

C. Pathway for laryngeal and hypopharyngeal tumour spread

N. Chidambaranathan; Chennai/IN

Learning Objectives

1. To become familiar with the anatomy of the larynx and hypopharynx.
2. To learn which imaging technique to use.
3. To understand the typical local and remote spread of laryngeal and hypopharyngeal tumours.


Supraglottic tumours constitute 30% of laryngeal tumours. Epiglottic tumours primarily invade the pre-epiglottic space (PES), base of tongue and the paraglottic space (PGS) laterally. Tumours from petiole of epiglottis invade the low PES and extend to the glottis/subglottis through the anterior commissure. Tumours originating from the false vocal cord, laryngeal ventricle or aryepiglottic fold primarily infiltrate the PGS. Tumours arising from arytenoids and inter-arytenoid regions tend to infiltrate post-cricoid region of hypopharynx. Lymphatic spread (levels II,III&IV nodes) is common. Glottic tumours (~65%) arise from the anterior half of the true vocal cords and spread anteriorly to the anterior commissure, contralateral cord and thyroid cartilage via Broyle's ligament, or posteriorly into the posterior commissure, arytenoids, cricoarytenoid joint and cricoid cartilage. The tumour can extend superiorly to the PES and PGS or inferiorly to the subglottis. Lymphatic spread is uncommon. Subglottic tumours (~5%) are usually inferior extensions of glottic or supraglottic tumours. Primary subglottic tumours spread to the trachea, thyroid gland and cervical oesophagus. Lymphnode metastases involve pre/para-tracheal nodes. Hypopharynx consists of pyriform sinus, posterior hypopharyngeal wall and post-cricoid region. Pyriform sinus tumours spread to thyroid cartilage laterally, endolarynx medially, post-cricoid region infero-medially, posterior pharyngeal wall posteriorly and base of tongue superiorly. Growths in the posterior pharyngeal wall invade the pre-vertebral fascia, whereas post-cricoid growths spread inferiorly to the cervical oesophagus and antero-laterally to thyroid. CT is the preferred imaging modality for evaluating laryngeal carcinoma, while MRI is useful as a problem-solving adjunct, especially early cartilage involvement.

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