The pyriform fossa has a rich lymphatic drainage. Seventy five percent of patients will have metastatic lymph nodes at presentation, half of which, will have bilateral nodes. Direct spread may occur into the tongue or into the cervical oesophagous. Lateral tumours usually present as a lump in the neck. Medial lesions usually affect the larynx causing hoarseness.
Many post-cricoid tumours are pyriform fossa tumours that have spread down, or cervical oesophageal lesions that have spread up. Twenty percent of cases will have a metastatic lymph node at presentation.
Half of posterior pharyngeal wall tumours have a palpable lymph node in the neck at presentation.
Last reviewed 01/2018