- Determine pathology of lymph node: Fine needle aspiration cytology (FNAC) / core needle biopsy / surgical biopsy
- Try to identify primary tumour
- Symptoms related to upper aerodigestive tract, prior skin cancers
- Examine nose, nasopharynx, oral cavity, oropharynx, hypopharynx, larynx, skin, thyroid
- Palpate tonsils, base of tongue and retract tonsillar pillars, and then re-examine for bleeding
- Cystic nodes: suspect oropharynx / skin cancer
- Nodal location and laterality suggest location of primary
- Levels 1a,b: Oral cavity, nose, sinuses
- Levels 2, 3: Oral cavity, oropharynx, hypopharynx, larynx, nose, sinuses
- Level 4: Larynx, hypopharynx, thyroid, oral tongue, floor of mouth
- Level 5: Nasopharynx, posterior scalp, thyroid
- Level 6: Thyroid, subglottis, hypopharynx, oesophagus
- Nodes along external jugular vein: Facial skin
- Bilateral: Midline, base of tongue, soft palate, supraglottis, hypopharynx, nasopharynx (NPC)
- Immunohistochemistry: EBV (NPC); P16 (oropharynx, skin, nasopharynx, oral cavity); melanoma; thyroid; salivary; lymphoma etc.
- CT or MRI or PET (Law of diminishing returns and additional costs with >1 imaging modality)
- Panendoscopy, guided biopsies, tonsillectomy
- Exclude distant metastases: CXR / CT / PET
- Stage the cancer
- Select appropriate treatment, preferably as a multidisciplinary team
- Cure vs palliation
- General fitness to undergo surgery +/ (chemo)radiation
- Ability to deal with consequences of treatment
Index: Clinical Practice Guidelines for CUP
Resource Appropriate CUP Guideline Scenarios
Like this:
Like Loading...