How do you approach the work up and surgery for H&N SCC of unknown primary?

Topics: Head and Neck Cancers • Radiation Oncology

Do you recommend for EUA/biopsies/tonsillectomies to look for primary as well as neck dissection (at the same time to save a trip to the OR), or attempt to find the primary first, then decide on neck dissection + RT vs. definitive CRT after?

Answer from: Radiation Oncologist at Academic Institution

CT max, face, neck and chest. PET is ok but has a high false positive rate in the oropharynx where the primary is likely located in the US. Direct laryngoscopy and ipsilateral tonsillectomy. Bilateral tonsillectomy is ok but low yield (less than 5%). Biopsy base of tongue. Lingual tonsillectomy is o...

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Radiation Oncologist at Vanderbilt-Ingram Cancer Center
Assuming negative imaging (we favor PET/CT but are...

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