A Comprehensive Approach to the Management of Occult Primary with Secondaries in the Neck Lymph Nodes: A Tertiary Hospital Based Study in Andhra Pradesh
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 6, Issue 8
Abstract
Background: An unknown primary is defined as a squamous cell carcinoma (SCC) presenting in a lymph node or nodes in the neck with no primary index site in the head and neck having been identified. Aim of the Study: The aim of the study was to analyze the clinical, investigative, and therapeutic results of patients with occult primary with secondaries in the neck lymph nodes. Materials and Methods: A prospective cross-sectional analytical study on 49 adult patients with malignant neck masses with unknown primary was conducted. Demographic data, clinical symptomatology and clinical examination of the neck masses were completed. Ear, nose, throat examination, video laryngoscopy, nasopharyngoscopy, and clinical staging of the neck lymph nodes were done according to tumor-node-metastasis classification. Fine needle aspiration cytology (FNAC)/ultrasound guided FNAC, core biopsy and/or open biopsy of the lymph nodes were done. Selective neck dissection, modified radical neck dissection was done with or without radiotherapy (RT) or chemotherapy. All the data were analyzed with standard statistical methods. Observations and Results: A total of 49 adult patients with neck nodal metastases without primary being identified; 32 males and 17 female patients with M:F ratio of 1.88:1. The mean age was 53.42 ± 4.10 years in males and 57.35 ± 3.80 years in females. 16/49 (32.65%) patients were seen in the age group of 50–65 years, 13/49 (26.53%) in 35–50 years age group, 11/49 (22.44%) in 65–80 years age group, and 9/49 (18.36%) in 20–35 years age group. The most common symptom was mass in the neck (100%) followed by pain in 6/49 (12.24%). Overall, symptoms excluding presentation of mass in the neck accounted for <10% in this study. Levels II and III involvement, in this study was 41/49 (83.67%)followed by Level IV 6/49 (12.24%) patients. Conclusions: Patients with occult primary and secondaries in the neck should be investigated with positron emission tomography-computed tomography scan, magnetic resonance imaging, FNAC, true cut biopsy, to totally rule out the presence of primary site of the malignant tumor in the aerodigestive tract before embarking on the treatment of the nodal metastases. The treatment should include radical surgical treatment of the nodal metastases followed by RT. Adjunct chemotherapy could be added wherever necessary. If total mucosal irradiation is to be considered, then intensity modulated radiation therapy should be used. Follow-up should be same as for the patients with the known primary.
Authors and Affiliations
Katari Sudhakar, M Ravikumar
Keywords
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