Cervical lymph nodes from an unknown primary tumor in 190 patients

Article Abstract:

Diagnosis and treatment of an isolated neck mass requires a logical, systematic evaluation. The authors use needle aspiration and panendoscopic examination of the ear, nose and throat as the basis of assessment. If diagnosis is still not possible based upon the study of the cells removed by needle aspiration, exploratory surgery may be necessary. Exploratory cervicotomy (incision into the neck) is performed with excisional biopsy and frozen-section diagnosis of the specimen; this allows immediate appropriate treatment. A retrospective review was undertaken of 475 patients who had isolated neck masses. Evaluation of these patients revealed 190 patients (40 percent) with cervical lymph nodes from an unknown squamous cell carcinoma. There were 188 patients (44 percent) who had lymphomas that were localized in the neck area, and half of these were cases of Hodgkin's disease. There were 78 patients (16 percent) who had benign (noncancerous) tumors; 10 patients had other malignancies and 9 had nervous tumors. Treatment consisted of surgery and radiotherapy in 86 patients; radiotherapy alone in 84 patients, chemotherapy in 13 patients, and 7 patients had no treatment. Local recurrence occurred in 51 percent of the patients, and distant metastasis (spread) in 27 percent; the primary tumor appeared in 16 percent. When needle aspiration and radical neck dissection with radiotherapy were performed, the failure rate was 15 percent (7 of 47 patients). When needle aspiration and modified dissection with radiotherapy were performed (5 of 12 patients), or when adenectomy and radiotherapy were performed (5 of 12), failure was 42 percent. When incisional biopsy was performed prior to subsequent radical neck dissection, the failure rate was 54 percent. It is recommended that needle aspiration be performed first to obtain diagnosis; if this fails cervical exploration with frozen section is recommended. Radical neck dissection is preferred in unknown squamous cell carcinoma primary tumor. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Cancer, Cancer diagnosis, Lymphatic metastasis

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Hypothyroidism following combined treatment for hypopharyngeal and laryngeal carcinoma

Article Abstract:

Following laryngectomy (excision of the larynx, the organ of voice) the condition of some patients may gradually deteriorate. Patients may complain of fatigue, loss of interest in daily activities, and changes in personality may occur. This depressive syndrome may be due to hypothyroidism (decreased activity of the thyroid gland) caused by injury during surgery or radiation therapy. A prospective study was undertaken over a four-year period to determine the incidence of hypothyroidism in patients with pharyngeal or laryngeal cancer who underwent surgery followed by radiotherapy. There were 32 patients studied, all were men, and the average age was 58 years. None had a history of previous thyroid disease. Radical surgery was performed for 30 patients, and 31 patients received radiation therapy; one patient refused further treatment. All patients had normal thyroid function tests prior to surgery; after treatment, thyroid tests were repeated at three-month intervals. As part of their neck surgery, 12 patients had hemithyroidectomy, removal of half of the thyroid gland. After an average of six months, seven of these patients developed hypothyroidism. Of the 20 patients who did not undergo the additional thyroid surgery, four patients developed hypothyroidism an average of 10 months after treatment. Patients treated with replacement of thyroid hormone showed an improvement in their general condition with decrease in depressive symptoms. These findings indicate that hypothyroidism is very common after combined surgical and radiotherapy treatment for pharyngeal and laryngeal cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Hypothyroidism, Laryngeal cancer, Laryngectomy

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