Hi Brian, Lymph node primaries can result from lymphoma which sometimes explains why there is a presentation in a cervical lymph node with no other tumor present. When excisional BX is done, then pathology reveals the type of cells present. In SCC-HN it would be squamous cells, in lymphoma, it would be lymphoma cells; other types of cancer, that specific type of cancer cell would be found in the lymph node. However, a SCC does not start in a lymph node--as live&love might be thinking. It must come from a part of the body lined with squamous epithelia. Lymph nodes are comprised of lymph tissue. I am not a medical professional, but I found out this information from doctors and from doing research on-line.

As a 25 year survivor of non Hodgkin's lymphoma, (likely a cascade event form exposure to defoliants) I can tell you that there are multiple other symptoms besides an enlarged painless node that accompany lymphatic cancers. You know well before you have some surface nodal presentation (most of them are buried deep within you) that you are genuinely sick. Since this forum is and oral cancer forum I won't go through the list.

What we are talking about here are oral cancers, and specifically why in some people who have SCC in their lymph nodes after a fine needle aspiration and biopsy, (obviously from the mouth or throat where squamous cells reside), have no visual presentation of the disease in their mouths that we would normally see in tobacco oral carcinogenisis. No one has said here that a lymph node is ever a primary in oral cancers, and for that matter in most other cancers, as it is a central collection point of metastasis - your lymphatic system is part of your immune system trying to clear things from your body ranging from the detritus of infections to cancer.

Breast cancer patients have regional spread to lymph node under their arm pits and in their thorax, testicular and prostate cancer patients have spread to the nodes in the groin etc., because the lymph system is trying to do it's job. So if you go back and read the original posting, the statement was in relation to the question was why oral cancers can sometimes be occult and show up as a cervical node first find even though that is never the primary; not the multiple reasons a lymph node might be cancerous.

By the by, a lymph dissection and biopsy for a suspect lymphoma cancer will always find lymphoid cells in the node, as that is what it is made from - just in lymphoma some of those cells which are there will have the cellular change that make then cancerous lymph cells vs. normal lymph cells. This is a cascade of a disease that is primarily composed of malignant lymphocytes. Lymphocytes are a normally occurring part of the white blood cell series, all part of your immune defensive system.

[quote=Brian Hill]Lymph nodes are part of your immune system, and a primary pathway for your body to eliminate toxins and other waste byproducts of infections and the like. They are a place that we find cancer metastasizing to, but they are never the location of a primary cancer. [/quote]

Brian-I am sorry, but you misread my post. I was only correcting the statement you made as quoted above. And, you are wrong about a neck presentation being a late manifestation of lymphoma. It is precisely what my husband's oncologist and ENT suspected prior to his excisional biopsy. By the way, FNA's routinely give false negatives for many types of cells and are often inadequate in dianosing lymphoma as well as SSC.

In addition, someone in fact DID mention that SCC may have started in a lymph node. Please refer to live&love's question in the first post on this thread where she asks if it could have started in a lymph node.

I am sorry if I have offended you.

No offense taken . We are just trying to get the best information out possible. I suspect I should have said (never thought someone would relate the comment to something other than oral cancer on an oral cancer board) that in oral cancers, nodes are never the primary. In 12 years I have never read about one being so in any peer review journal, nor heard of one here at OCF, or on the many cancer programs I lecture on routinely. As to the lymphoma, respectfully, having been there personally and having my abdomen swell and be the site of the main early manifestations of it, I think I have some knowledge here that is valid.

Those here for the last decade have all discussed for years the value, or lack thereof of FNA's so we all know that they have a less than 100% accuracy rate. I said for people that had them with a positive finding....They miss things because of the random nature of the punctures, but positive findings when they occur in the aspirate and in subsequent histopathology, are not a shortcoming of FNA's and in that case they are accurate as a diagnostic procedure.

There is never any issue asking for further explanation of something or suggesting that something was misstated. The worst thing that can happen on these boards is for us to put out bad information that might hurt someone. SO as a final clarification - an enlarged neck node can be a sign of lymphoma, BUT NOT IF THE ASPIRATION TURNS UP SCC IN IT, which is what we are talking about here. The answer to live and loves question is correct, oral cancer doesn't start in a cervical node.

I have also been told by 3 doctors, if there is SCC found in lymph nodes, that there is always going to be a primary in the mouth or "throat" area, as they are squamous cells, and that's why it is squamous cell carcinoma.

Also with lymphoma, I had a friend that just went through that, and she actually didn't have any lymph nodes in her neck involved, she had a tumor in her chest, which was odd, cuz it wasn't near where your lymph nodes are "supposed to be". They are usually found near your armpits or in your neck and hers was in the center of her chest, well slightly off center, but no where near the axillary lymph nodes.

I have since talked to 3 docs (1 ent, 1 oral surgeon and 1 oncologist), and they say if SCC is found in the lymph nodes, they better be looking for the primary in the oral cavity or throat, as they have never heard of a primary of oral cancer in0the lymph nodes, especially when it is SCC in their combined 70 years of treating oral cancer, and head and neck cancers.

You do understand that you can have SCC in your mouth and it can not be visible, ie. occult, meaning buried in the tissues of the tonsil perhaps, looking totally normal (absent)to examiners. At that size it can also be missed by scanning technologies that typically look at slices that are about 5mm between each view. So the unknown primary issue, many times is just occult, not unknown. The Hopkins experience on consecutive patients with positive cervical nodes and occult oral environments found just this. 70% of them had a small 2mm primary buried deep in the tonsil when those normal looking tonsils were excised and biopsied. This is occult, not absent. And there is no argument that SCC has to originate from squamous tissues, and the closest ones to the neck are in the mouth, that is a forgone conclusion. I don't get what people don't get about all this in this post.

Sorry, but I'm out of this conversation.