The presence of metastases in the cervical lymph nodes without the presence of a primary tumor means that after a general diagnosis, the primary ENT tumor was not detected.
Usually these are metastatic cervical lymph nodes of an epidermoid or undifferentiated type of carcinoma. Micro-puncture of ganglion provides a diagnosis. A cervicothoracic scan is also performed, PET with 18F (fluorodeoxyglucose (FDG)), ENT-panendoscopy under general anesthesia, tonsillectomy and homolateral lymph nodes. All these tests will help make an accurate diagnosis and evaluate the possible treatment and prognosis.
In a certain number of clinical cases, metastases in the cervical lymph nodes, without detecting primary cancer, are treated by excision of the affected ganglion and further irradiation of the lymph nodes and mucosa in order to control the disease of the lymph node and prevent the occurrence of primary cancer.
Target volumes of radiation therapy are determined individually in accordance with:
- the presence or absence of human papillomavirus (HPV) and Epstein-Barr virus (EBV),
- immunohistochemical data with histopathological options.
Chemotherapy is usually performed (with cisplatin 100 mg / m2) in conjunction with radiotherapy.
For radiotherapy, a radiation therapy method with modulation of the intensity of VMAT (modulated volumetric arc therapy) is used. The delivered dose is 70 Gy if there is a metastatic ganglion, and 45/50 Gy in the ganglionic areas at risk and the ENT mucosa in the risk group (oropharynx in the presence of HPV +). For some patients, one-sided radiation therapy can be performed. This allows to reduce side effects, such as xerostomia, while providing good local-regional control of the disease.