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In planning the therapy of nasopharyngeal cancer, one must pay particular attention to the real and potential lymph node metastases, since as many as 90% of the patients may have clinically positive nodes on presentation for treatment. The nasopharynx has an extensive lymphatic capillary plexus, and it is quite common for a patient to present with neck nodes, and with the nasopharynx primary either very tiny, or not seen at all.
The neck node metastases are every bit as curable by irradiation as the primary lesion if the technique and dosages are utilized as outlined below. In fact, failure to control neck node metastases is rarely the only cause of failure in our nasopharyngeal experience.
Neck Node Spread
Although the afferent lymphatics usually drain into the nodes on the same side as the lesion, there are abundant anastamoses across the midline; even small, well-lateralized lesions may present with contralateral metastases.
Million RR. Management of Neck Node Metastases. JAMA. 1972;220(3):402-405. doi:10.1001/jama.1972.03200030060017