0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12
Head and Neck Cancer 659malignancies, neuroendocrine carcinoma, sarcomas all much
less frequent)
■If only a neck mass:
➣Ddx depends on age of patient, duration of mass (present how
long), inflammatory signs (fever, erythema, tenderness), and
prior history of malignancy. In an adult, includes branchial
cleft cyst, lymphadenitis, lymphoma, parotid tumor (if at tail of
parotid), and metastases from non head and neck sites as well as
rare primary sarcomas. In a HIV (−) adult, 80% of neck masses
are malignant and 80% of these are metastases from a head and
neck site In a child, lymphadenitis is common (including bac-
terial and viral, Cat Scratch, and tuberculous etiology), with the
others all possible.management
What to Do First
■Referral to a physician or otolaryngologist, for Dx and coordination
of care.
General Measures
■General assessment of health, especially cardiopulmonary, to assess
surgical risk
■Metastatic evaluation: at least CXR, AST/ALT; possible chest CT
■If primary site inapparent, not unreasonable to obtain FNA of
neck mass (though recommend referral: he/she will do FNA,
etc.)specific therapy
Treatment Alternatives
■Complex: dependent on numerous factors
■Treatment strategies include:
➣EBRT (external beam radiation therapy) or surgical resec-
tion for limited disease; Organ preservation approaches (ini-
tial EBRT with concomitant cisplatin as a radiosensitizer) or
combined treatment (surgery and EBRT) for advanced disease.
Complex radiation planning, including hyperfractionation and
brachytherapy, often play a role.
■For NPC, treatment includes cisplatin and RT concomitantly fol-
lowed by three cycles of chemotherapy with cisplatin and 5-
fluorouracil.