Metastatic Squamous Cell Carcinoma to the Cervical Lymph Nodes From an Unknown Primary Cancer: Management in the HPV Era (original) (raw)
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Cervical lymph node metastasis of squamous cell carcinoma from unknown primary tumor
The first aim of the study was to determine the survival rate of the patients with Carcinoma of the Unknown Primary (CUP) in relation to lymph node status and eventual later identification of the primary tumor. To second one was to investigate the impact of PET-CT on identification of the primary tumor. We studied 97 patients sent to our University Medical Center with diagnosis of metastasis of unknown primary tumor between 1.1.1997 and 1.9.2009. All patients had panendoscopy and some had PET-CT at later period. All susceptible patients had a surgery and postoperative radiation therapy. After the completed their treatment they were followed up at ENT department. With preoperative examinations we discovered 48 primary tumors. Only in one case of 13 the PET-CT detected the primary tumor not confirmed with other examination methods. After the treatment we found primary tumors in 10 patients. In 39 patients we didn't discover any primary tumor. The 2-year overall survival for 10 patients with found tumor was 80.0%, the 2-year overall survival for the 39 patients without discovered tumor was 73.8%. The 2-year disease-specific survival for 10 patients with found tumor was 90.0%, the 2-year disease-specific survival for 39 patients without discovered tumor was 81.6%. The 2-year overall survival for high neck level lymph node metastasis group (N=36) was 80.1%, the 2-year overall survival for low neck level lymph node group (N=13) was 61.5%. PET-CT method was not particularly useful in detecting primary tumors in patients with metastasis with unknown primary. Patients with high neck level lymph node metastasis had statistically significant better survival.
Evaluation and management of malignant cervical lymphadenopathy with an unknown primary tumor
Otolaryngologic Clinics of North America, 2005
Periodically physicians involved in the management of head and neck cancer encounter a patient with biopsy-demonstrated carcinoma within a cervical lymph node but with no clinically detectable primary tumor site within the upper aerodigestive tract. Presumed metastatic carcinoma within cervical lymph nodes with an unknown primary site is relatively rare, representing only 3% to 5% of all head and neck cancers [1]. Explanations for this phenomenon are speculative, and although the roles of panendoscopy (directed laryngoscopy, esophagoscopy, bronchoscopy) and directed biopsies are generally accepted, many questions about how to employ and interpret new radiographic technologies and about appropriate management remain unanswered. This article reviews current information regarding the diagnostic evaluation of the patient with malignant cervical disease with an unknown primary tumor site, prognostic indicators for these patients, and treatment strategies. Etiology Carcinoma metastatic to the neck with an unknown primary tumor site accounts for approximately 3% to 5% of all head and neck cancers. Most patients with metastatic cervical adenopathy have squamous cell carcinoma
European Archives of Oto-Rhino-Laryngology, 2006
In patients with a neck metastasis from an unknown primary with non-squamous cell cancer (non-SCC) histology, the primary is often located outside the head and neck area. We retrospectively evaluated 326 patient records and found 14 patients with non-SCC neck lymph node metastasis from an unknown primary undergoing whole body F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) with or without coregistered computed tomography (PET/CT). The PET or PET/CT findings were verified by pathological work-up, additional imaging tests, and clinical follow-up. PET detected pathological FDG uptake suspicious for the primary in eight patients. PET or PET/CT findings were true positive in seven patients, true negative in 4, false positive in 1, and false negative in two patients. In one patient PET/CT revealed a synchronous ovarian carcinoma. The results suggest that whole body imaging with FDG PET and PET/CT can be useful to identify unknown primaries of non-SCC origin. However, the work-up of patients undergoing PET or PET/CT in our study was very heterogeneous and the primary was more likely found in patients without extensive imaging before PET scanning. Further studies should evaluate if the histology of a neck nodal metastasis should influence the choice of the imaging method and the role of PET and PET/CT imaging for the work up of patients with a non-SCC neck lymph node metastasis of an unknown primary
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India, 2007
The cervical lymphadenopathy due to metastasis carry poor prognosis. The status of cervical nodes is of critical interest to surgical, radiation and medical oncologists who manage patients with head and neck cancers. We conducted a prospective randomized study to assess the role of palpation, ultrasound and CT in detection of cervical metastasis in 25 patients presented to us with head and neck malignancy irrespective of cervical nodal status. It was observed that clinical examination was least sensitive (73.33%) when compared with computerized tomography (80%) and ultrasound (93.93%). The computerized tomography was found to be most specific (90%) when compared to clinical examination or ultrasonography (70% each).
International Journal of Cancer
Treatment of patients with neck lymph node metastasis of squamous cell carcinoma (SCC) from unknown primary tumor (NSCCUP) is challenging due to the risk of missing occult tumors or inducing toxicity to unaffected sites. Human papillomavirus (HPV) is a promising biomarker given its causal link to oropharyngeal SCC and superior survival of patients with HPV-driven oropharyngeal SCC and NSCCUP. Identification of HPV-driven NSCCUP could focus diagnostic work-up and treatment on the oropharynx. For the first time, we assessed HPV antibodies and their prognostic value in NSCCUP patients. Antibodies against E6 and E7 (HPV16/18/31/33/ 35), E1 and E2 (HPV16/18) were assessed in 46 NSCCUP patients in sera collected at diagnosis, and in follow-up sera from five patients. In 28 patients, HPV tumor status was determined using molecular markers (HPV DNA, mRNA and cellular p16 INK4a). Thirteen (28%) NSCCUP patients were HPV-seropositive for HPV16, 18, 31, or 33. Of eleven patients with HPV-driven NSCCUP, ten were HPV-seropositive, while all 17 patients with non-HPV-driven NSCCUP were HPV-seronegative, resulting in 91% sensitivity (95% CI: 59-100%) and 100% specificity (95% CI: 80-100%). HPV antibody levels decreased after curative treatment. Recurrence was associated with increasing levels in an individual case. HPV-seropositive patients had a better overall and progression-free survival with hazard ratios of 0.09 (95% CI: 0.01-0.42) and 0.03 (95% CI: 0.002-0.18), respectively. For the first time, seropositivity to HPV proteins is described in NSCCUP patients, and high sensitivity and specificity for HPV-driven NSCCUP are demonstrated. HPV seropositivity appears to be a reliable diagnostic and prognostic biomarker for patients with HPV-driven NSCCUP.
International Journal of Clinicopathological Correlation
Cervical cancer is the most common genital tract malignancy among women, accounting for many deaths in developing countries like India. . Most of the metastasis to neck nodes arise from primary tumors of the head andneck. 54 year old multiparous postmenopausal woman with a lump in left side of her neck. Ultrasound of the neck revealed multiple enlarged hypoechoic lymphnodes, FNAC showed carcinomatous deposits in the nodes. no pallor, icterus or pedal edema. PAP smear showed atypical cells arranged predominantly in clusters, few singly scaterred and occasional ones in vague acinar pattern. atypical cells have round oval nucleus, increase nuclear cytoplasic ration, hyperchroatic nuclei, irregular nuclear borders, nuclear overlapping with moderate amount of cytoplasm and tumour diasthesis which was interpretated as adenocarcinoma. The prognosis for metastatic carcinoma of the cervix is poor and metastases to the neck signals a grave prognosis.