Metastatic squamous neck cancer with occult primary
Metastatic squamous neck cancer with occult primary is a rare form of cancer characterized by the spread of squamous cells from an unknown primary site to the lymph nodes in the neck or around the collarbone. This condition is often associated with common cancer risk factors, including tobacco use, unhealthy diet, alcohol abuse, and genetic predispositions, as well as the influence of the human papillomavirus (HPV) in head and neck cancers. Patients may present with symptoms such as neck or throat lumps, pain, and metastasis. Diagnosis typically involves a combination of physical examinations, biopsies, and imaging tests to identify the presence of cancer and to rule out any primary tumor. Treatment strategies vary based on the number of affected lymph nodes, the presence of a primary tumor, and the patient's overall health. Approaches may include surgical procedures such as radical neck dissection, radiation therapy, and chemotherapy, with some patients benefiting from clinical trials for advanced cases. The prognosis can vary widely, with three-year survival rates for disease-free patients ranging from 40 to 50 percent, influenced by the extent of metastasis and treatment response. Addressing modifiable risk factors, such as smoking cessation, may help reduce the incidence of this condition.
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Metastatic squamous neck cancer with occult primary
ALSO KNOWN AS: Metastatic squamous cell carcinoma of the neck from an unknown primary
RELATED CONDITIONS: Head and neck cancers; metastatic squamous neck cancer
DEFINITION: Metastatic squamous neck cancer with occult primary is a cancer in which squamous cells (cells from tissues that line the outside of many body organs) metastasize to lymph nodes in the neck or around the collarbone, and the location of the primary tumor is unknown.
Risk factors: The risk factors for metastatic cancer are the same as those for cancer in general. They include tobacco use, unhealthful diet, alcohol abuse, and genetic factors. In addition, the human papillomavirus as a has been extensively studied in head and neck cancers.
Etiology and the disease process: In the course of the disease, the cancer cells that divide too quickly and without any order travel from the organ in which they develop (the primary site) through the blood or lymphatic vessels to the lymph nodes in the neck or around the collarbone.
Incidence: Metastatic squamous neck cancer with occult primary is a rare disease that afflicts less than 200,000 individuals in the United States.
Symptoms: Symptoms may include a lump in the neck or throat, pain in the neck or throat, and metastasis.
Screening and diagnosis: Screening tests to diagnose metastatic squamous neck cancer and the primary tumor include physical exams, biopsies, and imaging procedures. A diagnosis of the disease is made if the primary tumor is not found during testing. Staging is the process used to determine how far the tumor has spread to other body organs, such as the liver or lungs.
The American Joint Committee on Cancer (AJCC) outlines the standard staging process for metastatic squamous neck cancer with occult primary. The patient's human papillomavirus (HPV) p16 status or Epstein-Barr virus (EBV) status allows practitioners to determine the stage of their condition. If the patient is EBV positive, the staging system for nasopharyngeal cancer should be adopted. If the patient is HPV positive or negative, staging for p16-positive or p16-negative oropharyngeal cancer should be used, respectively.
Treatment and therapy: The treatment of the disease depends on how many lymph nodes are affected, whether the primary tumor has been detected, and the patient’s age and overall health. In a surgery treatment called radical neck dissection, physicians cut out cancerous lymph nodes and some of the healthy ones around them. Radiation therapy, to kill the cancer cells and to shrink the tumors, may be given alone or before surgery. Chemotherapy is often administered with or before radiation or hyperfractionated radiation therapy. Some patients respond well to platinum-based combination chemotherapy. Treatment options for advanced tumors include participation in clinical trials of new treatments.
Prognosis, prevention, and outcomes: Prognosis and outcome depend on many factors, such as the extent of metastasis in the lymph nodes or the cancer's response to treatment. Avoiding preventable risk factors, such as smoking, may help reduce risk. Three-year survival rates following surgery or radiation for patients who are disease-free are between 40 and 50 percent.
Bibliography
Hermans, Robert. Head and Neck Cancer Imaging. 3rd ed., Springer, 2021.
"Metastatic Squamous Neck Cancer with Occult Primary Treatment (PDQ®)." National Cancer Institute, www.cancer.gov/types/head-and-neck/patient/adult/metastatic-squamous-neck-treatment-pdq. Accessed 20 June 2024.
Niederhuber, John E., Joel E. Tepper, Martin D. Abeloff, M. B. Kastan, James O. Armitage, James H. Doroshow. Abeloff's Clinical Oncology. 6th ed., Saunders, 2020.
Popescu, Bogdan, at al. "Methods of Investigating Metastatic Lymph Nodes in Head and Neck Cancer." Maedica: A Journal of Clinical Medicine, vol. 8, no. 4, 2013, pp. 384–87. www.maedica.ro/articles/2013/4/MAEDICA‗art‗17.pdf.
Shah, Jatin P., Bhuvanesh Singh, and Snehal G. Patel. Jatin Shah's Head and New Surgery and Oncology. 5th ed., Elsevier/Mosby, 2020.