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Neck lymph nodes, carcinoma of unknown primaries (CUP), neck dissection…
Neck lymph nodes, carcinoma of unknown primaries (CUP), neck dissection
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metastases
From head and neck
mainly: laryngeal, tonsil, pyriform recess, nasopharynx, oral cavity cancers
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rarely:nose and sinuses, ear, thyroid cancer
From distant organs
lung, kidney, stomach cancers & malignant melanoma
Neck dissections
- elective neck dissection N0
- therapeutic neck dissection N1-3
Classification
A. Comprehensive
- Radical
- Modified radical
Type I n. XI preserved
Type II n. XI and jugular vein preserved
Type III n. XI, jugular vein and SCM preserved
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- 10% (+) necks
- localisation: retropharyngeal and jugulodigastric nodes
- treatment: neck dissection
palpable nodes
radiographic evidence of disease
CUP - syndrome
- presence of neck metastasis (N1-N3) when the primary tumor is unknown (Tx) or diagnosed with delay
- CUP - syndrome is present in 2-20% of patients with malignant tumor
- CUP – syndrome in ENT – about 5%
- hou line: border in neck metastasis ( below clavicle 40% , above 60%)
squamous cells, anapaestic, lymphoepithelioma, adenocarcinoma
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Detection
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true CUP syndrome
- 55% patients – during follow-up
- 25% patients – never
Treatment
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- 5-year survival: 26 – 55%
- Better results when metastasis is above Hou line
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