Surgical removal of the tumor and lymphadenectomy of the cervical (neck) lymph nodes can also be taken up at the main treatment method instead of radiation. And remaining cancer cells post surgery are treated with chemoradiation.• Stage III and IVA: In this stage the cancer cells metastasize into the local tissues and cervical lymph nodes. The treatment used in these cases is chemo radiation. Any remaining cancer cells post chemoradiation are surgically removed. Lymphadenectomy may also be done after treatment with chemoradiation if the cancer cells have infiltrated the cervical lymph nodes. Another method of treatment includes, first, surgical removal of tumor as well as cervical lymph nodes followed by chemoradiation or radiation to decrease the chances of recurrence.• Stage IVB: In this stage the cancer has already undergone distant metastasis, hence showing poor prognosis. The treatment includes chemotherapy, cetuximab or both. Radiation may be used to aid in relieving symptoms arising from the cancer and also to prevent further development of complications. Lymphatic infiltration
Nearly half of the patients with anterior pillar lesions and three fourths of the patients with tonsillar fossa lesions have nodal metastasis at the time of presentation itself. Metastasis of cancer cells to cervical lymph nodes diminishes the chance of cure. Specially, if there is evidence of metastasis of cancer cells beyond the lymph node capsule. Though, some data indicates that the metastasis of cancer cells outside the lymph node capsule is a bad prognosis for HPV-unrelated oropharynx cancer than it is for HPV-related oropharynx.
Subcortical dementias includes those diseases which predominantly affects the basal ganglia along with features of cognitive decline. Diseases such as progressive supranuclear palsy, Huntingtons chorea and Parkinsons disease are different in many features from the other cortical dementias like Alzheimers disease. Yet these patients present clinically with mild forgetfulness and slowed thought process along with abnormal movements and problems with motility. Clinical features
Clinically subcortical dementia usually is seen with features like slowness of mental processing, forgetfulness, impaired cognition, lack of initiative-apathy, depressive symptoms (such as anhedonia, negative thoughts, loss of self-esteem and dysphoria), loss of social skills along with extrapyramidal features like tremors and abnormal movements.In most of the patients with Huntingtons diseases the first clinical feature to appear is the change in personality. The dementia is more severe in patients with early onset of Huntingtons disease. Parkinsons disease is characterised by features of dementia in older age. The adult type "leukodystrophy" also causes subcortical dementia with prominent frontal lobe features. As a general rule the earliest symptoms in "cortical" dementia include difficulty with high-level behaviors such as memory, language, problem-solving and reasoning, mathematics and abstract thoughts – functions associated with the cerebral cortex. Such patients have prominent apraxia and agnosia. However, in "subcortical" dementia these high-level behaviours are less affected. Pathophysiology
In most common types of dementias there is widespread degeneration in the cerebral cortex – such as the plaques and neuro fibrillary tangles which are the hallmark of Alzheimers disease. In subcortical dementia, there is targeted damage to regions lying under the cortex.