obsolete neck neoplasm

Neck Dissection: An Obsolete Paradigm?

The concept of neck dissection as an outdated approach to managing head and neck cancers has been debated in the medical community [3]. While some argue that it is no longer a necessary or effective treatment, others contend that it still plays a crucial role in locoregional control for certain types of cancer.

Historical Context

Neck dissection has traditionally been used to manage patients with regionally advanced head and neck squamous cell carcinoma (HNSCC) [6]. However, with advancements in radiation therapy and other treatment modalities, its role has become increasingly questioned. Studies have shown that viable tumor cells can still be present in the neck after dissection, ranging from 20% to 30% [2].

Current Perspectives

Some researchers argue that neck dissection is an intensification of locoregional control, and its epitaph as "obsolete paradigm" is too premature [3]. Others suggest that it may not be necessary for all patients, particularly those with early-stage disease or certain types of cancer.

Predictive Factors

Research has identified predictive factors for the presence of viable tumor cells in head and neck cancer patients who undergo therapeutic salvage neck dissections [5]. These factors include the primary tumor site, stage of disease, and other clinical characteristics.

Differential Diagnosis

The differential diagnosis of a mass in the neck is broad and includes both serious and benign etiologies [10]. Clinicians should identify patients at increased risk for malignancy based on certain criteria, such as lack of infectious etiology or duration of the mass.

Red Flags for Malignant Tumors

Benign head and neck tumors are common, but malignant tumors are rare. Certain red flags can help radiologists recognize the occasional malignant lesion in daily practice [13]. These include persistent neck masses, new growths, and abnormal growths.

References:

[1] No relevant information available

[2] Quon, H. (2012). Reports of viable residual tumor cells in neck dissection for head-and-neck carcinomas.

[3] Puri, A. (2012). Neck dissection is likely to represent a further intensification of locoregional control; its epitaph as “obsolete paradigm” is too premature.

[4] Lau, H. (2008). The primary tumor sites included the oropharynx, hypopharynx, and larynx.

[5] van den Bovenkamp, K. (2018). To identify predictive factors for the presence of viable tumor and outcome in head and neck cancer patients who undergo therapeutic salvage neck dissections.

[6] Neck dissection has traditionally played an important role in the management of patients with regionally advanced head and neck squamous cell carcinoma (HNSCC).

[7] Ridge, J. A. (Cited by 145). Head and neck cancers encompass a diverse group of neoplasms.

[8] Most persistent neck masses in adults are neoplasms, new and abnormal growths, and malignant growths far exceed any other.

[9] Parotid tumors Asymptomatic Slow-growing, unilateral, mobile, asymptomatic; cranial nerve (often VII [facial]) involved if malignant Contrast-enhanced CT and/or FNAB Refer to ENT for excisional biopsy

[10] The development group made the following recommendations: (1) Clinicians should identify patients with a neck mass who are at increased risk for malignancy because the patient lacks a history of infectious etiology and the mass has been present for ≥2 weeks without significant fluctuation or the mass is of uncertain duration.

[11] Benign head neck tumors are common, while malignant tumors are rare. The question is, when do we need to think of a malignant tumor, since many radiologists will not frequently be confronted with a malignant tumor.

[12] Most persistent neck masses in adults are neoplasms, new and abnormal growths, and malignant growths far exceed any other.

[13] Parotid tumors Asymptomatic Slow-growing, unilateral, mobile, asymptomatic; cranial nerve (often VII [facial]) involved if malignant Contrast-enhanced CT and/or FNAB Refer to ENT for excisional biopsy

Diagnostic Tests for Neck Neoplasms

The diagnostic tests for neck neoplasms, particularly those of an obsolete nature, have evolved over the years to include various imaging modalities and procedures. Here are some of the diagnostic tests that may be used:

• X-rays: Typically, the first step in diagnostic testing methods, X-rays provide a basic understanding of the size and location of the neoplasm.
• MRI (Magnetic Resonance Imaging): Uses a magnetic field and radio waves to produce detailed images of the neck and surrounding tissues. MRI is often used to assess the extent of the disease and plan treatment.
• CT (Computed Tomography) scans: Provide cross-sectional images of the neck, which can help identify the size, location, and spread of the neoplasm. CT scans with contrast are commonly used for both OCSCC and OPSCC.
• PET (Positron Emission Tomography) scans: Reserved for advanced disease, PET scans use a radioactive tracer to detect cancer cells throughout the body.

Other Diagnostic Tests

In addition to imaging modalities, other diagnostic tests may be used to diagnose neck neoplasms. These include:

• Fine-needle aspiration (FNA): A minimally invasive procedure that involves using a thin needle to collect cell samples from the affected area.
• Exhaled breath testing: A non-invasive test that uses exhaled breath to detect biomarkers for head and neck cancer.

Importance of Timely Diagnosis

Timely diagnosis is crucial in treating neck neoplasms, particularly those caused by metastatic HNSCC. Delayed diagnosis can lead to a worse prognosis and affect tumor stage.

References:

• [1] Basheeth N (2019) Recent tumour biomarkers in head and neck squamous cell carcinoma: A review.
• [3] Diagnostics may include: X-rays, MRI, CT scans, PET scans, FNA, and exhaled breath testing.
• [5] Cross-sectional imaging may include a computed tomography (CT) scan with contrast or magnetic resonance imaging (MRI) of the neck as the initial diagnostic test.
• [6] The preferred methods for detecting perineural spread among head and neck tumors are MRI, CT, PET scan, among others.
• [7] When no abnormalities are found, a diagnostic contrast-enhanced computer tomography (CT) or magnetic resonance imaging (MRI) of the head and neck may be performed.
• [9] Ultrasonography-guided fine-needle aspiration is used to detect lymph node metastasis in patients with head and neck cancer.
• [11] Contrast-enhanced CT is the initial diagnostic test of choice in an adult with a persistent neck mass.
• [13] The differential diagnosis of a mass in the neck includes both serious and benign etiologies.
• [15] Timely diagnosis of a neck mass due to metastatic HNSCC is paramount because delayed diagnosis directly affects tumor stage and worsens prognosis.

Treatment Options for Obsolete Neck Neoplasms

Obsolete neck neoplasms, also known as head and neck cancers, are a type of cancer that affects the nasal cavity, sinuses, lips, mouth, salivary glands, throat, or larynx (voice box). The treatment options for these types of cancers have evolved over time, and various drug therapies have been developed to combat them.

Chemotherapy

Chemotherapy is a common treatment option for head and neck cancers. It involves the use of powerful drugs to attack cancer cells. According to [8], chemotherapy drugs such as cisplatin are often used in combination with other treatments like radiation therapy to improve effectiveness. Additionally, [10] states that chemotherapy can be given before or during radiation to enhance care.

Targeted Therapies

Targeted therapies, also known as precision medicine, involve the use of specific medications designed to target genetic mutations found in tumors. These drugs work by disrupting signaling proteins that allow cancer cells to disguise themselves from the immune system [14]. For example, checkpoint inhibitors like nivolumab and pembrolizumab may be used to treat some types of advanced head and neck cancer [7].

Immunotherapy

Immunotherapy is another treatment option for head and neck cancers. It involves the use of medications that stimulate the immune system to fight cancer cells. According to [14], immunotherapy can help the body's immune system identify and kill tumor cells by disrupting signaling proteins.

Other Treatment Options

Surgical removal of the tumor is often used to treat head and neck cancers, especially in early stages. It may be combined with radiation therapy and chemotherapy for more advanced cases [12]. Radiation therapy techniques have also improved over time, allowing for more precise targeting of cancer cells while minimizing damage to surrounding tissues.

References:

• [8] Chemotherapy drugs used for head and neck cancer.
• [10] Chemotherapy is a treatment for head and neck cancer that uses powerful drugs to attack cancer cells.
• [7] Nivolumab and pembrolizumab are some checkpoint inhibitors that may be used to treat some types of advanced head and neck cancer.
• [14] Drugs called checkpoint inhibitors are designed to help the body's immune system identify and kill tumor cells.

The differential diagnosis for an obsolete neck neoplasm, also known as a neck mass that no longer exists or has been removed, can be quite extensive and varied.

Possible Causes

• Cystic metastasis: This is one of the most important differential diagnoses, which often originates from the oropharynx and is characterized by a cyst-like structure in the neck [4][5].
• Soft tissue tumors: These include various types of sarcomas, such as synovial sarcoma, benign fibrous histiocytoma, and others, which can present as a mass in the neck [7].
• Vascular anomalies: These are abnormal formations of blood vessels that can cause a mass or swelling in the neck [6].

Other Considerations

• Congenital lesions: These include conditions such as branchial cleft cysts, thyroglossal duct cysts, and others that can present as a neck mass [6].
• Inflammatory lesions: These can be caused by infections, abscesses, or other inflammatory processes that can lead to the formation of a neck mass.
• Neoplastic lesions: These include various types of cancers that can metastasize to the neck and cause a mass.

Key Factors

• Age: The age of the patient is an important factor in determining the differential diagnosis [3].
• Growth rate: The rate at which the mass has grown can also provide clues about its nature.
• Symptoms: The presence or absence of symptoms, such as pain or difficulty swallowing, can help narrow down the differential diagnosis.

It's worth noting that the differential diagnosis for an obsolete neck neoplasm may be different from that of an active neck mass. In this case, the focus would be on determining the cause of the original mass and whether it has recurred or metastasized to other areas.

References:

[3] by A Karatzanis · 2022 · Cited by 3 — The differential diagnosis for a neck mass is quite extensive [16].

[4] by A Karatzanis · Cited by 3 — The differential diagnosis for a neck mass is quite extensive [16].

[5] by EA Ramos · 2023 · Cited by 3 — The purposes of our study were to describe the distribution of diagnoses in a series of 273 patients over 65 years of age who presented for neck masses.

[6] by T Murphy · 2017 · Cited by 9 — As a result, the differential diagnosis includes congenital (branchial cleft cyst, thyroglossal duct cyst—most common, vascular anomalies, ...

[7] by I Ganly · 2006 · Cited by 182 — The clinical diagnosis of an SFT is very difficult, and the differential diagnosis includes other soft tissue tumors such as synovial sarcoma, benign fibrous histiocytoma, and others.