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Revista de la Asociación Médica del Centro Médico ABC

2016, Number 1

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An Med Asoc Med Hosp ABC 2016; 61 (1)

Cervical lymph node metastases of squamous cell carcinoma from unknown primary. Current diagnostic and therapeutic approach

Gallegos HJF

Language: Spanish
References: 30
Page: 25-32
PDF size: 211.89 Kb.


ABSTRACT

Introduction: When lymph node metastases are identified in the neck, but the clinical, imaging and endoscopic evaluation do not allow identifying the primary tumor, then a diagnosis of unknown primary metastasis is determined. Objective: To offer readers the current foundations of the diagnostic and therapeutic approach of this neoplasm. Methodology: Review of current scientific evidence to support diagnosis and treatment of cervical metastases from an unknown primary. Results: Most cervical metastases with unknown primary are from epidermoid carcinoma, the most frequent tumor originating in head and neck mucosae; in this entity, most patients have neoplasm confined to the supraclavicular area; therefore, it is unnecessary to carry out a systematic search. Lack of a primary tumor obliges us to treat not only the neck, but the sites of likely primary and contralateral neck; however, morbidity implied in this treatment has currently brought disputes regarding this routinely used practice. Most patients cannot be treated with a single therapeutic variety, and must undergo surgery, radiotherapy or a combination of chemo-radiotherapy; the key to the therapeutic decision is the proper staging. The intensity modulated radiation therapy, and the value of human papillomavirus and Epstein-Barr virus in the etiology of head and neck cancer have changed this entity’s therapeutic approach. Conclusion: Metastases of unknown primary are often of epidermoid origin; staging and identification of risk factors allow to select the therapeutic strategy to follow.


REFERENCES

  1. Barrera FJ, Rojas CA. Metástasis cervicales de cáncer primario desconocido. En: Barrera FJL, Gallegos HJF, Granados GM, Gurrola MH, Hernández CA, editores. Cáncer de cabeza y cuello. México: Alfil; 2015. pp. 213-223.

  2. Shah J, Patel S, Sinh B. Cervical lymph nodes. In: Shah J, Patel S, Sinh B, editors. Jatin Shah’s Head and neck surgery and oncology. 4th ed. Philadelphia: Mosby Elsevier; 2012. pp. 426-470.

  3. Koivunen P, Bäck N, Laranne J, Irjala H. Unknown primary: diagnostic issues in the biological endoscopy and positron emission tomography scan era. Curr Opin Otolaryngol Head and Neck Surg. 2015; 23 (2): 121-126.

  4. Nair S, Mohan S, Niakantan A, Gupta A, Malik A, Gipta A. Impact of (18)f-fluorodeoxyglucose positron emission tomography/computed tomography scan on initial evaluation of head and neck squamous cell carcinoma: our experience at a tertiary care center in India. World J Nucl Med. 2015; 14: 19-24.

  5. Keller F, Psichogios G, Linke R, Lell M, Kuwert T, Iro H et al. Carcinoma of unknown primary in the head and neck: comparison between positron emission tomography (PET) and PETC/CT. Head Neck. 2011; 33 (11): 1569-1575.

  6. Granados VF, Medrano GR, Rodríguez CAS. Metástasis cervicales de primario desconocido. En: Arturo Sergio Rodríguez Cuevas, editor. Tumores de cabeza y cuello. 2.ª ed. México: Manual Moderno; 2003. pp. 243-252.

  7. Dolan RW, Anderson TD. Practical applications of in-office fiberoptic transnasal esophagoscopy in the initial evaluation of patients with squamous cell cancer of the head and neck. Ear Nose Throat J. 2013; 92 (issue 9): 450-455.

  8. Krishna SM, James S, Balaram P. Expresion of VEGF as prognosticator in primary nasopharyngeal cancer and its relation to EVB status. Virus Res. 2006; 115 (1): 85-90.

  9. O’Malley BB. Head and neck imaging. In: Shah JP. Atlas of clinical oncology. Cancer of the head and neck. Hamilton: BC Decker; 2001. pp. 57-74.

  10. Mydlarz WK, Liu J, Blanco R, Fakhry C. Transcervical ultrasound identifies primary tumor site of unknown primary head and neck squamous cell carcinoma. Otolaryngol Head Neck Surg. 2014; 151 (16): 1090-1092.

  11. Lee JR, Kim JS, Roh JL, Lee JH, Baek JH, Cho KJ et al. Detection of occult primary tumors in patients with cervical metastases of unknown primary tumors: comparison of (18)F FDG PET/CT with contrast-enhanced CT or CT/MR imaging-prospective study. Radiology. 2015; 274 (3): 764-771.

  12. Gallegos-Hernández JF, Paredes-Hernández E, Flores-Díaz R, Minauro-Muñoz GG, Apresa-García T, Hernández-Hernández DM. Human papillomavirus: association with head and neck cancer. Cir Cir. 2007; 75 (3): 151-155.

  13. Soria D, Canchola G, Lara CO, Sánchez JF, Hernández RE, Ortiz C. Carcinoma epidermoide orofaríngeo metastásico a ganglios linfáticos cervicales asociado a los subtipos 16 y 45 del virus del papiloma humano (VPH). Estudio clínico, morfológico y molecular de dos casos. Gac Med Mex. 2013; 149: 673-679.

  14. Flores C, Hernández DM, Gallegos JF. El virus del papiloma humano como factor pronóstico en pacientes con carcinoma de cabeza y cuello. Cir Cir. 2010; 78 (3): 221-228.

  15. Keane FK, Chen YH, Neville BA, Tishler RB, Schoenfield JD, Catalano PJ et al. Changing prognostic significance of tumor stage and nodal stage in patients with squamous cell carcinoma of the oropharynx in the human papillomavirus era. Cancer. 2015; 121: 2594-2602.

  16. Kobayashi K, Saito Y, Omura G, Ando M, Sakamoto T, Yamasoba T et al. Clinical features of human papilloma virus-related head and neck squamous cell carcinoma of an unknown primary site. ORL J Otorhinolaryngol Relat Spec. 2014; 76: 137-146.

  17. Zuh L, Wang N. 18F-fluorodeoxyglucose positron emission tomography-computed tomography as a diagnostic tool in patients with cervical nodal metastases of unknown primary site: a meta-analysis. Surg Oncol. 2013; 22: 190-194.

  18. Thawley SE, Panje WR, Batsakis JG, Lindberg RD. Comprehensive management of head and neck tumors. 2nd ed. Philadelphia: Saunders Company; 1999.

  19. Troussier I, Barry B, Baglin AC, Leysalle A, Janot F, Baujat B et al. [Target volumes in cervical lympadenopathies of unknown primary: toward a selective customized approach? On behalf of REFCOR]. Cancer Radiother. 2013; 17 (7): 686-694.

  20. Harmoir M, Troussier I, Machiels JP, Reychler H, Schmitz S, Thariat J et al. Lymph node metastases from squamous cell carcinoma of unknown primary site. Is it time to change of paradigm? Bull Cancer. 2014; 101 (5): 455-460.

  21. Piret P, Werenne X, Sautois B, Demez P, Coucke P. What is the standard treatment approach for a cervical lymph node metastasis from a squamous cell carcinoma of unknown origin? Rev Med Liege. 2014; 69 Suppl 1: 58-62.

  22. Gallegos JF, Minauro MGG, Ortiz M AL, Luna CM. Disección radical de cuello. En: Barrera FJL, Gallegos HJF, Granados GM, Gurrola MH, Hernández CA, editores. Cáncer de cabeza y cuello. México: Alfil; 2015. pp. 45-54.

  23. Bernier J, Cooper JS, Pajak TF, van Glabbeke M, Bourhis J, Forastiere A et al. Defining risk levels in locally advanced head and neck cancers: a comparative analysis of concurrent postoperative radiation plus chemotherapy trials of the EORTC (#22931) and RTOG (# 9501). Head Neck. 2005; 27 (10): 843-850.

  24. Patil VM, Prabhash K, Noronha V, Joshi A, Muddu V, Dhumal S et al. Neoadjuvant chemotherapy followed by surgery in very locally advanced technically unresectable oral cavity cancers. Oral Oncol. 2014; 50 (10): 1000-1004.

  25. Schouten CS, de Graaf P, Alberts FM, Hoekstra OS, Comans EF, Bloemena E et al. Response evaluation after chemoradiotherapy for advanced nodal disease in head and neck cancer using diffusion-weighted MRI and 18F-FDG-PET-CT. Oral Oncol. 2015; 51 (5): 541-547.

  26. Gallegos-Hernández JF. Head and neck cancer. Risk factors and prevention. Cir Cir. 2006; 74 (4): 287-293.

  27. Seoane J, Takkouche B, Varela-Centelles P, Tomás I, Seoane-Romero JM. Impact of delay in diagnosis on survival to head and neck carcinomas: a systematic review with meta-analysis. Clin Otolaryngol. 2012; 37 (2): 99-106.

  28. Strojan P, Ferlito A, Langendijk JA, Corry J, Woolgar JA, Rinaldo A et al. Contemporary management of lymph node metastases from an unknown primary to the neck: II. a review of therapeutic options. Head Neck. 2013; 35 (2): 286-293.

  29. Martin JM, Galloway TJ. Evaluation and management of head and neck squamous cell carcinoma of unknown primary. Surg Oncol Clin N Am. 2015; 24 (3): 579-591.

  30. Keller LM, Galloway TJ, Holdbrook T, Ruth K, Yang D, Dubyk C et al. p16 status, pathologic and clinical characteristics, biomolecular signature, and long-term outcomes in head and neck squamous cell carcinomas of unknown primary. Head Neck. 2014; 36 (12): 1677-1684.




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