RESUMO
Lymph node metastasis (LNM) is an important prognostic factor in head and neck cancer (HNC), which leads to recurrence and poor outcome. Despite the advances in multimodality treatment protocols, overall survival in patients with LNM remains limited, thus calling for the need of a more thorough understanding of the biology in metastatic process. In the past, LNM had been suspected to rely mostly on passive mechanistic impulse from primary tumor. However, recent discovery of new lymphatic markers, regulating growth factors, and cognate receptors, has elucidated the active biological regulation during metastatic cascades, which primarily involves primary tumor lymphangiogenesis, pre-metastatic niche formation, and sentinel LNM. In this review, we discuss recent literatures on the mechanisms of LNM in HNC that is expected to allow a better understanding of the disease as well as suggesting a potential clinical implication.