Lymphatic Drainage

Question 1

Ovaries

Answer 1

Para-aortic lymphatics via the gonadal vessels

Question 2

Uterine fundus

Answer 2

Runs with the ovarian vessels and may thus drain to the para-aortic nodes. Some drainage may also pass along the round ligament to the inguinal nodes.

Question 3

Body of the uterus

Answer 3

Drains through lymphatics contained within the broad ligament to the iliac lymph nodes

Question 4

Cervix

Answer 4

Drains into three potential nodal stations:

• laterally through the broad ligament to the external iliac nodes
• along the lymphatics of the uterosacral fold to the presacral nodes
• posterolaterally along lymphatics lying alongside the uterine vessels to the internal iliac nodes

Question 5

Anterior two thirds of the tongue

Answer 5

Minimal communication of lymphatics across the midline, so metastasis to the ipsilateral nodes is usual

Question 6

Posterior third of the tongue

Answer 6

Communicating networks, as a result early bilateral nodal metastases are more common in this area

Question 7

Tip of the tongue

Answer 7

Pass to the sub mental nodes and from there to the deep cervical nodes

Question 8

Mid portion of the tongue

Answer 8

Drain to the submandibular nodes and then to the deep cervical nodes. Mid tongue tumours that are laterally located will usually drain to the ipsilateral deep cervical nodes, those from more central regions may have bilateral deep cervical nodal involvement.

Question 9

Superior aspect of the vagina

Answer 9

The internal and external iliac nodes

Question 10

Inferior aspect of the vagina

Answer 10

Superficial inguinal nodes

Question 11

Lateral surface of the upper half of the auricle

Answer 11

Drains to the superficial parotid lymph nodes

Question 12

Cranial surface of the superior half of the auricle

Answer 12

Drains to the mastoid nodes and deep cervical lymph nodes

Question 13

Lower half of the auricle and lobule

Answer 13

Drain into the superficial cervical lymph nodes

Question 14

Vocal cords

Answer 14

No lymphatic drainage and this site acts as a lymphatic watershed

Question 15

Supraglottic part of the larynx

Answer 15

Upper deep cervical nodes

Question 16

Subglottic part of the larynx

Answer 16

Prelaryngeal and pretracheal nodes and inferior deep cervical nodes

Question 17

Aryepiglottic fold and vestibular folds

Answer 17

Dense plexus of lymphatics associated with them and malignancies at these sites have a greater propensity for nodal metastasis

Question 18

Upper third of the oesophagus

Answer 18

Deep cervical lymph nodes

Question 19

Mid third of the oesophagus

Answer 19

Mediastinal lymph nodes

Question 20

Lower third of the oesophagus

Answer 20

Gastric lymph nodes

Question 21

Breast

Answer 21

70% Axillary nodes
Internal mammary chain
Other lymphatic sites such as deep cervical and supraclavicular fossa (later in disease)

Question 22

Left side of the head and neck

Answer 22

Lymphatics join the thoracic duct prior to its insertion into the left brachiocephalic vein

Question 23

Right side of the head and neck

Answer 23

Lymphatics drain via the subclavian and jugular trunks into the right lymphatic duct and thence into the mediastinal trunk and eventually the right brachiocephalic vein

Question 24

Scrotum

Answer 24

Inguinal lymph nodes

Question 25

Testes

Answer 25

Para-aortic nodes

Question 26

Spongy urethra (penile urethra)

Answer 26

Deep inguinal nodes

Question 27

Glans penis

Answer 27

Deep inguinal nodes

Question 28

Prostatic urethra

Answer 28

Internal iliac nodes

Question 29

Membranous urethra

Answer 29

Internal iliac nodes

Question 30

Parotid gland

Answer 30

Deep cervical nodes