<prompt> Metastasis to neck lymph nodes is from?Breast cancerLung cancerAdrenal carcinomaStomach cancer  <response>: Ans. B Lung cancerRef: Schwartz 10th ed. 583; Harrison 18th ed Ch 99Metastasis to Cervical lymph NodesSquamous cell carcinoma SCC is the most common histotype, followed by adenocarcinoma, undifferentiated carcinoma and other malignancies for example, lymphoma and melanomaCommon site for metastasis to neck nodes - Head and Neck M.C., Lungs 2nd M.C., esophagus, stomatch, ovary, pancreas. Approximately ten percent of patients with abnormal cervical nodes present without obvious primary. Most common sites for unknown primary: Nasal Pharynx. Pyriform Sinus. Tongue Base Tonsillar Crypts. Thyroid Lung.DRAINAGE Sites for Cervical Lymph NodesThe left supraclavicular node is called Virchows node since it is on the left side of the neck where the lymphatic drainage of most of the body from the thoracic duct enters the venous circulation via the left subclavian vein. The metastasis blocks the thoracic duct leading to regurgitation into the surrounding nodes i.e. virchows node.RememberProbable Source of Nodal Metastasis Level 1: Oral cavity, submandibular gland. Level 2: Nasal pharynx, oral pharynx, parotid, superglottic larynx. Level 3: Oral pharynx, hypopharynx, superglottic larynx. Level 4: Subglottic larynx, hypopharynx, esophagus, thyroid. Level 5: Nasal pharynx, oral pharynx. Level 6 7: Thyroid, larynx, lung. Note: Bilateral nodes are common with cancers of soft pallet, tongue, epiglottis, and nasal pharynx. 