Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12

658 Head and Neck Cancer

(OP) using mirror or fiberoptic endoscopy. Palpation of base of

tongue (BOT) and inspection & palpation of neck also essential.

Check for MEE.

95% of time visible or palpable primary detectable

5% “unknown” primary: confirmed neck disease by fine needle

aspiration (FNA)... see below, but no obvious primary

tests

Laboratory

■EBV IgA viral capsid antigen (VCA) often elevated in NPC; otherwise

no specific tests indicated. However metastatic evaluation (AST/ALT

and CXR) appropriate

Imaging

■MRI

➣almost always superior to CT for soft-tissue imaging: aids in eval-

uating

➣extent of primary & extent of neck nodes

➣may assist subsequent radiation therapy planning and in fol-

lowup

■CT and MRI

➣fail to detect small involved neck nodes 20–30% of time

■Role of PET:

➣not fully established, but high-resolution PET scanning may aid

in identifying unknown primary, additional second lung carci-

noma, or metastatic disease in neck/chest/liver. Post-treatment,

may assist in cancer surveillance.

Biopsy

■FNA of neck mass may confirm SCC when primary inapparent. FNA

may not be necessary if primary is biopsy-proven (or soon will be)

■Prior to planning treatment, biopsy of primary usually indi-

cated. May be done at time of “panendoscopy” (direct laryn-

goscopy, fiberoptic bronchoscopy, and esophagoscopy under gen-

eral anesthesia): assesses extent of primary, evaluates for second

malignancy, affords biopsy opportunity

differential diagnosis

■When primary apparent, biopsy is diagnostic:

➣SCC by far most common (lymphomas, salivary gland