1.
Define unknown primary cancer of the head and neck? What is the TNM staging classification for unknown primary? Provide the most common neoplasms that present as unknown primary?
2.
Discuss the accepted theories in pathophysiology of unknown primary cancer of the head and neck.
3.
What is the work up for a patient with a malignant neck mass without any associated mucosal lesions?
Reference(s):
Cianchetti, M., Mancuso, A. A., Amdur, R. J., Werning, J. W., Kirwan, J., Morris, C. G., & Mendenhall, W. M. (2009). Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site. The Laryngoscope, 119(12), 2348–2354.
4.
How can the cervical level a malignant neck mass presents at help you in finding possible primary site? What are the most common mucosal primary sites responsible for unknown primary neck masses?
5.
What is the benefit in finding possible primary mucosal site for unknown primary?
6.
Role of PET scan in unknown primary.
Reference(s):
Miller, F. R., Hussey, D., Beeram, M., Eng, T., McGuff, H. S., & Otto, R. A. (2005). Positron emission tomography in the management of unknown primary head and neck carcinoma. Archives of Otolaryngology–Head & Neck Surgery, 131(7), 626–629.
7.
What is superior in detecting primary site for unknown primary?
Reference(s):
Haerle, S. K., Strobel, K., Hany, T. F., Sidler, D., & Stoeckli, S. J. (2010). (18)F-FDG-PET/CT versus panendoscopy for the detection of synchronous second primary tumors in patients with head and neck squamous cell carcinoma. Head & Neck, 32(3), 319–325.
8.
Should an unknown primary patient with negative PET scan undergo operative panendoscopy?
Reference(s):
Pattani, K. M., Goodier, M., Lilien, D., Kupferman, T., Caldito, G., & Nathan, C.-A. O. (2011). Utility of panendoscopy for the detection of unknown primary head and neck cancer in patients with a negative PET/CT scan. Ear, Nose, & Throat Journal, 90(8), E16-20.
9.
Should all unknown primary necks undergo neck dissection?
Reference(s):
Aslani, M., Sultanem, K., Voung, T., Hier, M., Niazi, T., & Shenouda, G. (2007). Metastatic carcinoma to the cervical nodes from an unknown head and neck primary site: Is there a need for neck dissection? Head & Neck, 29(6), 585–590.
10.
IMRT and unknown primary treatment.
11.
What is the role of HPV and survival in unknown primary?
Reference(s):
Compton, A. M., Moore-Medlin, T., Herman-Ferdinandez, L., Clark, C., Caldito, G. C., Wang, X. I., … Nathan, C.-A. O. (2011). Human papillomavirus in metastatic lymph nodes from unknown primary head and neck squamous cell carcinoma. Otolaryngology–Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 145(1), 51–57.
12.
What is transoral laser microsurgery and how can it help in unknown primary diagnosis?
Reference(s):
Karni, R. J., Rich, J. T., Sinha, P., & Haughey, B. H. (2011). Transoral laser microsurgery: a new approach for unknown primaries of the head and neck. The Laryngoscope, 121(6), 1194–1201.