Diagnosis and management of neck metastases from an unknown primary.
Diagnosis and management of neck metastases from an unknown primary.
复制标题
原发灶不明的颈部转移瘤的诊断和治疗。
DOI：
--
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发表时间：
2005
影响因子：
2
通讯作者：
F. Chiesa
中科院分区：
文献类型：
--
作者：
L. Calabrese;B. Jereczek;J. Jassem;A. Rocca;R. Bruschini;R. Orecchia;F. Chiesa
在所有原发部位不明的癌症患者中，隐匿性原发癌的颈淋巴结转移约占5%-10%。上颈部和中颈部（I-II-III-V级）的转移通常归因于头颈癌，而下颈部（IV级）的转移通常与锁骨下的原发灶有关。诊断程序包括仔细的临床评估和纤维内镜检查的头部和颈部粘膜，活检从所有可疑的网站或盲目从网站的可能起源的主要，计算机断层扫描和磁共振。最常见的组织学发现是鳞状细胞癌，特别是当上颈部受累时。在这些情况下，一个系统的扁桃体切除术的可疑病变的情况下进行了讨论，因为高达25%的原发性肿瘤可以检测到在这个网站。如果腺癌累及下颈部，应注意胸、腹原发灶（特别是肺、食管、胃、卵巢或胰腺）。正电子发射断层扫描与氟-2-脱氧-D-葡萄糖允许检测原发性肿瘤在约25%的情况下，但这种程序仍然被认为是研究。治疗方法包括手术（颈淋巴结清扫术），有或没有术后放疗，单纯放疗和放疗后手术报告的几个指南。在早期（N1），颈淋巴结清扫术和放射治疗似乎有相似的疗效，而更先进的情况下（N2，N3）需要联合方法。放射治疗的范围（双侧颈部和粘膜照射与同侧颈部放射治疗）仍然存在争议。广泛放射治疗的潜在益处应与其急性和晚期发病率以及随后原发病出现时再照射的困难进行权衡。其他方法的作用，如化疗和热疗，仍有待确定。
Neck lymph node metastases from occult primary constitute about 5%-10% of all patients with carcinoma of unknown primary site. Metastases in the upper and middle neck (levels I-II-III-V) are generally attributed to head and neck cancers, whereas the lower neck (level IV) involvement is often associated with primaries below the clavicles. Diagnostic procedures include a careful clinical evaluation and a fiberoptic endoscopic examination of the head and neck mucosa, biopsies from all suspicious sites or blindly from the sites of possible origin of the primary, computerized tomography scan, and magnetic resonance. The most frequent histological finding is Squamous Cell Carcinoma, particularly when the upper neck is involved. In these cases, a systematic tonsillectomy in the absence of suspicious lesions is discussed since up to 25% of primary tumours can be detected in this site. Thoracic, and abdominal primaries (especially from lung, oesophagus, stomach, ovary or pancreas) should be sought in the case of adenocarcinoma and involvement of the lower neck. Positron emission tomography with fluoro-2-deoxy-D-glucose allows detection of primary tumour in about 25% of cases, but this procedure is still considered investigational. Therapeutic approaches include surgery (neck dissection), with or without post-operative radiotherapy, radiotherapy alone and radiotherapy followed by surgery as reported by several guide-lines. In early stages (N1), neck dissection and radiotherapy seem to have similar efficacy, whereas more advanced cases (N2, N3) require combined approaches. The extent of radiotherapy (irradiation of bilateral neck and mucosa versus ipsilateral neck radiotherapy) remains debatable. A potential benefit from extensive radiotherapy should be weighed against its acute and late morbidity and difficulties in re-irradiation in the case of subsequent primary emergence. The role of other methods, such as chemotherapy and hyperthermia, remains to be determined.
影响因子：
158.5
作者：
Bernier, J;Domenge, C;van Glabbeke, M
通讯作者：
van Glabbeke, M
DOI：
--
发表时间：
1999-07
期刊：
The cancer journal from Scientific American
影响因子：
--
作者：
Safa Aa;Luu Tran;Sheila Rege;Brown Cv;Mandelkern Ma;Wang Mb;A. Sadeghi;Guy Juillard
通讯作者：
Safa Aa;Luu Tran;Sheila Rege;Brown Cv;Mandelkern Ma;Wang Mb;A. Sadeghi;Guy Juillard
影响因子：
10.3
作者：
Gillison, ML;Koch, WM;Sidransky, D
通讯作者：
Sidransky, D