Metastatic Squamous Cell Carcinoma to the Cervical Lymph Nodes From an Unknown Primary Cancer : Management in the HPV Era

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Int Head & Neck Sci Grp , Civantos , F J , Vermorken , J B , Shah , J P , Mäkitie , A A & Ferlito , A 2020 , ' Metastatic Squamous Cell Carcinoma to the Cervical Lymph Nodes From an Unknown Primary Cancer : Management in the HPV Era ' , Frontiers in oncology , vol. 10 , 593164 . https://doi.org/10.3389/fonc.2020.593164

Title: Metastatic Squamous Cell Carcinoma to the Cervical Lymph Nodes From an Unknown Primary Cancer : Management in the HPV Era
Author: Int Head & Neck Sci Grp; Civantos, Francisco J.; Vermorken, Jan B.; Shah, Jatin P.; Mäkitie, Antti A.; Ferlito, Alfio
Contributor: University of Helsinki, HUS Head and Neck Center
Date: 2020-11-10
Language: eng
Number of pages: 15
Belongs to series: Frontiers in oncology
ISSN: 2234-943X
URI: http://hdl.handle.net/10138/322853
Abstract: Background Patients with metastases in the lymph nodes of the neck and no obvious primary tumor, neck cancer with unknown primary (NCUP), represent a management challenge. A majority of patients have metastatic squamous cell carcinoma (SCC), although other histologies do occur. Methods We comprehensively reviewed the literature, compared available guidelines, and conferred with an international team of experts. Results Positron emission tomography-computed tomography (PET-CT) and fine needle aspiration (FNA) under ultrasound guidance increase accuracy of diagnosis. Immunohistochemistry (IHC), determination of human papilloma virus (HPV) status, by p16 staining or by in situ hybridization (ISH), and next-generation gene sequencing can guide us regarding probable primary sites and tumor biology. Narrow Band Imaging (NBI) has been introduced for the early detection of subtle mucosal lesions. Direct laryngoscopy (DL) and tonsillectomy have long been procedures used in the search for a primary site. More recently, TransOral Robotic Surgery (TORS) or Transoral LASER Microsurgery (TLM) have been introduced for lingual tonsillectomy. Conclusions New technologies have been developed which can better detect, diagnose, and treat occult primary tumors. Decisions regarding therapy are based on the primary tumor site (if discovered) and N stage. Options include neck dissection with or without postoperative adjuvant therapy, primary irradiation, or combined chemotherapy with irradiation. The preferred treatment of patients whose primary remains unidentified is controversial.
Subject: cervical adenopathy with unknown primary
HPV related head and neck cancer
non-HPV related head and neck cancer
molecular diagnoses occult primary
upper aerodigestive tract cancers
imaging head and neck cancer
transoral robotic surgery (TORS)
transoral laser microlaryngoscopy (TLM)
FINE-NEEDLE-ASPIRATION
TRANSORAL LASER MICROSURGERY
HUMAN-PAPILLOMAVIRUS
PRIMARY TUMORS
NECK-CANCER
WORK-UP
NASOPHARYNGEAL CARCINOMA
CONTEMPORARY MANAGEMENT
DIAGNOSTIC EVALUATION
ROBOTIC SURGERY
3122 Cancers
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