Approach to Metastatic Carcinoma of Unknown Primary in the Head and Neck: Squamous Cell Carcinoma and Beyond

Chernock, Rebecca D.; Lewis, James S.

doi:10.1007/s12105-015-0616-2

Cited by 62 publications

(57 citation statements)

References 37 publications

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“…Making up about 33% of cases, mucoepidermoid carcinoma is the most common type of malignant parotid gland tumour 6. Malignancy of the salivary glands is most commonly due to primary tumours, with metastases only accounting for 10% of tumours 7.…”

Section: Discussionmentioning

confidence: 99%

Parotid gland: an unusual site of breast cancer metastasis

2017

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Parotid gland metastases from breast cancer are an extremely rare and unusual event with a limited number of cases recorded in the literature. A 71-year-old woman with a history of ductal adenocarcinoma of the left breast presented to the maxillofacial clinic with an asymptomatic swelling of the left parotid gland. The presentation occurred 21 years after she underwent treatment for recurrent breast cancer. Investigations led to the diagnosis of a breast cancer metastasis which was oestrogen receptor and progesterone receptor positive and negative. Positron emission tomography scan confirmed this as a solitary metastasis. She was treated with aromatase inhibitors and a stable clinical response was observed on follow-up. Surgical intervention was avoided with its potential complications such as facial nerve injury. Metastasis from breast cancer to the parotid gland is a very rare phenomenon. However, in a patient with previous breast cancer, it should be considered as a possible differential diagnosis.

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Section: Discussionmentioning

confidence: 99%

Parotid gland: an unusual site of breast cancer metastasis

2017

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“…Lymfadenopa tia v oblasti II a III naznačuje možné origo v podnebnej mandli, koreni jazyka, hypo faryngu a supraglotickej časti hrtana. Na druhej strane lymfadenopatia v dolnej časti krku (level IV a Vb) svedčí skôr o pri márnom tumore mimo ORL oblasť (gas trointestinálny trakt, pľúca, prsník, uro genitálny trakt) [4,6]. Tieto výsledky sa potvrdili aj v našom súbore.…”

Section: Diskusiaunclassified

Carcinoma of Unknown Primary in Head and Neck Region

Uhliarova¹,

Navrátilová²,

Calkovský³

et al. 2018

Klin Onkol

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2 Klinika otorinolaryngológie a chirurgie hlavy a krku, UK JLF a UNM Martin SúhrnÚvod: Metastáza (MTS) do lymfatických uzlín (LU) na krku pri neznámom primárnom tumore sa dia gnostikuje u 5 % pa cientov s malígnym nádorom hlavy a krku. V manažmente pa cientov s MTS do LU na krku je vždy potrebné komplexné pátranie po okultnom nádore. Detekcia origa umožňuje cielenú špecifickú liečbu, čo výrazne zlepšuje prognózu choroby. Materiál a metodika: Retrospektívna ana lýza pa cientov, ktorí boli hospitalizovaní na Klinike otorinolaryngológie a chirurgie hlavy a krku UK JLF a UNM v Martine od januára 2012 do septembra 2017 pre MTS do LU krku pri neznámom primár nom tumore. Zamerali sme sa na dia gnostický postup a úspešnosť detekcie primárneho tumoru. Výsledky: V súbore bolo 40 pa cientov, priemerný vek 59,4 ± 1,5 rokov (35-78 rokov). CT vyšetrenie aj panendoskopické vyšetrenie v celkovej anestézii sa vykonalo u všetkých pa cientov. Ipsilaterálna tonzilektómia (TE) sa realizovala u 34 (80 %). U zvyšných 6 sa TE neindikovala -u 2 sa zistilo origo pri panendoskopickom vyšetrení a u 4 bola vykonaná TE v minulosti. Odber slepých vzoriek z nosohl tana, koreňa jazyka a piriformného recesu na histopatologické vyšetrenie sa vykonalo u 38 pa cientov (95 %). PET/ CT vyšetrenie sa indikovalo u 12 pa cientov (30 %). Primárny nádor sa nezobrazil ani u jed ného z nich. Po realizovaných vyšetreniach sa origo dia gnostikovalo u 21 (52,5 %). U 16 (40 %) sa pri márny nádor našiel v hornom aerodigestívom trakte, u 5 (12,5 %) sa primárny nádor nachádzal mimo ORL oblasť. U 19 (47,5 %) sa nepodarilo origo identifikovať. Záver: Aj napriek využitiu dostupných zobrazovacích a endoskopických metód nie je možné primárny tumor vždy identifikovať. Kĺučové slová metastáza do lymfatických uzlín na krku -neznámy primárny tumor -dia gnostika -PET/ CTpanendoskopia SummaryIntroduction: Carcinoma of unknown primary (CUP) in head and neck region is dia gnosed in 5% of patients with malignant tumour of head and neck. In the management of patients with CUP, complex investigation to dia gnose the occult tumour is always necessary. Detection of origin allows targeted specific treatment that significantly improves the prognosis of the dis ease. Material and methods: Retrospective analysis of patients treated at the Department of Otorhinolaryn gology and Head and Neck Surgery of the UK JLF and UNM in Martin between January 2012 until September 2017 for CUP in head and neck region. Dia gnostic procedure and success of primary tumour detection were evaluated. Results: In study group, there were 40 patients with average age 59.4 ± 1.5 years (35-78 years). CT scan and panendoscopic examination in general anaesthesia were performed in all patients. Ipsilateral tonsillectomy (TE) was performed in 34 patients (80%). For the remain ing 6 patients, TE was not indicated -2 found originally in the panendoscopic exa mination and in 4 TE was performed in the past. Blinded samples from the nasopharynx, the base of the tongue and the pyriform recess were taken in 38 patients (9...

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“…Treatment de‐intensification reduces toxicity for patients, however, without thorough upfront surgical evaluation, carries a risk for undertreatment of a missed primary. The majority of patients with initially occult primary tumors are eventually identified as having primary oropharyngeal cancers . In order to facilitate the identification of a primary site in patients with HNCUP a positron emission tomography/computed tomography (PET/CT) scan and direct laryngoscopy with biopsies of suspicious lesions and palatine tonsillectomy is often performed.…”

Section: Introductionmentioning

confidence: 99%

“…The majority of patients with initially occult primary tumors are eventually identified as having primary oropharyngeal cancers. 14 In order to facilitate the identification of a primary site in patients with HNCUP a positron emission tomography/computed tomography (PET/CT) scan and direct laryngoscopy with biopsies of suspicious lesions and palatine tonsillectomy is often performed. This approach identifies approximately 50% of initially occult tumors.…”

Section: Introductionmentioning

confidence: 99%

Pharyngeal‐sparing radiation for head and neck carcinoma of unknown primary following TORS assisted work‐up

Grewal

Rajasekaran²,

Cannady³

et al. 2019

The Laryngoscope

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Objective In patients with head and neck carcinoma of unknown primary (HNCUP;pT0) following TORS‐assisted workup, we have adopted a pharyngeal‐sparing radiation therapy (PSRT) approach targeting only the at‐risk neck and omitting treatment of the pharynx. We report outcomes following PSRT, and compare to institutional historical control subjects who received pharyngeal‐targeted RT (PRT). Methods Between 2009 and 2018, 172 patients underwent TORS‐assisted endoscopy as part of their workup for HNCUP. Following TORS, 54 patients had pT0 disease, of which 45 received RT. Forty‐nine percent received PSRT and 51% received PRT. Results No statistically significant differences existed between the PSRT and PRT groups with respect to overall nodal distribution, p16 positivity (55% vs. 43%, P = .12), neck dissection rates (77% vs. 65%, P = .51), and administration of chemotherapy (55% vs. 65%, P = .55). Median follow‐up for PSRT and PRT groups were 24 and 28 months, respectively (P = .04). Two‐year RFS was 86% and 74% for PSRT and PRT patients, respectively (log‐rank P = .30). Three and six patients recurred after PSRT and PRT, respectively. Two‐year OS for PSRT and PRT patients was 91% and 74%, respectively (log‐rank P = .31). Compared to PRT, PSRT was associated with statistically significantly less: grade 2+ mucositis (18% vs. 91%, P < .01), new opioid requirement (27% vs. 91%, P < .01), mean weight loss during RT (6.2 lbs vs. 17.4 lbs, P < .01), feeding tube placement during RT (5% vs. 43%, P < .01), and treatment‐related unplanned hospitalizations (9% vs. 39%, P = .04). Conclusion Following TORS‐assisted management of patients with pT0 HNCUP, we observed reduced toxicity following PSRT compared to PRT without apparent compromise of disease cure. Level of Evidence Level 3 evidence, retrospective review comparing cases and controls Laryngoscope, 130:691–697, 2020

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Approach to Metastatic Carcinoma of Unknown Primary in the Head and Neck: Squamous Cell Carcinoma and Beyond

Abstract: Metastatic carcinoma to cervical lymph nodes presenting as an unknown primary is quite common.

Cited by 62 publications

References 37 publications

Parotid gland: an unusual site of breast cancer metastasis

Parotid gland: an unusual site of breast cancer metastasis

Carcinoma of Unknown Primary in Head and Neck Region

Pharyngeal‐sparing radiation for head and neck carcinoma of unknown primary following TORS assisted work‐up

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