Assessing The Success Of A Strategy To Identify The Source Of Unknown Cancers

In some cases of cancer patients, the first presentation to a health care professional can be with a lymph node in the neck containing metastatic disease. The site of origin of cancer or the primary site is not always obvious, and further investigations are often needed to identify the source.

The standard workup of these patients involves taking a history, then an examination including flexible nasoendoscopy followed by conventional imaging (Computerised tomography (CT), Magnetic resonance imaging (MRI), and/or Positron Emission Tomography (PETCT). A Panendoscopy is carried out if imaging fails to detect the primary tumor; this is an examination of the upper aerodigestive tract with biopsies of the nasopharynx, hypopharynx, tonsillectomy, and targeted biopsies of the tongue base.

Despite all of these methods, the primary site may still not be identified. Transoral laser microsurgery (TLM) and Trans robotic surgery (TORS) of the tongue base are two new surgical techniques that are being increasingly used to help identify the site of the primary tumor. Both procedures involve removing the lymphatic tissue of the base of the tongue and preserving the underlying musculature, with the aim of identifying small cancer that cannot be seen during a clinical examination. In the literature, this is variably referred to as either lingual tonsillectomy or tongue base mucosectomy (TBM). We will use the latter to collectively describe these terms.

Our study is a systematic review and meta-analysis that aimed to assess the published literature on the use and efficacy of TBM in identifying the unknown primary site. We searched three main databases: MEDLINE, CINHAL, and EMBASE. We included studies that used a Transoral approach (TLM or TORS).

We identified 21 eligible studies with a total of 556 cases. 464 patients (83%) underwent TORS and 92 (17%) underwent TLM. Overall, Tongue base mucosectomy identified the primary tumor in the lingual tonsils in 58% of cases. However, this detection rate varied based on the diagnostic tests that had taken place prior to TBM. In patients who had negative clinical examination, negative CT/MRI imaging, negative PETCT, and negative EUA and biopsies, TBM identified the primary in the tongue base in 62% of cases. In 5 of the included studies, 90% or more of cases were positive for Human papillomavirus. In these cases, TBM successfully identified the primary site in 53% of cases. We also looked at the adverse events associated with the procedure. Our findings showed that hemorrhage was the most commonly reported adverse event in 4.9% of patients (13 studies).

Our study confirmed the high efficacy of TBM in identifying the primary site in cases of head and neck cancer, especially when other diagnostic methods have failed to identify the primary site.

These findings are described in the article entitled Transoral tongue base mucosectomy for the identification of the primary site in the work-up of cancers of unknown origin: Systematic review and meta-analysis, recently published in the journal Oral Oncology.

Speak Your Mind!

READ THIS NEXT

Animal Classification And Chart

Animals are lifeforms within the kingdom Animalia. From there, the classification of animals gets more specific, going through various other […]

Ancient Egypt Ink: Some Of The Oldest Tattoos In History

Tattoos may not be everybody‚Äôs cup of tea, but they have been part of many cultures for thousands of years. […]

Solar Pumps: Changing The Rural Agricultural Landscape 

Solar pumps are transforming the agricultural landscape throughout the developing world. The availability of energy throughout the year, as well […]

Admixed Populations: How To Correct For Ancestry Bias In Genetic Association Studies

Admixed populations pose a special challenge in genetic association studies due to the different proportions of a contribution of two […]

Tropical Rainforest Plants: From Rare To Common

The rainforests of the world are home to many fascinating and unique plants. These plants can be common or rare […]

Inactivation Of Serine Racemase: A Possible Treatment Strategy For Diabetic Retinopathy

Diabetic retinopathy (DR) is a leading cause of adult blindness and a deleterious complication of diabetes mellitus. After a decade […]

Using Green Solvents To Extract Oil From Wet Yeast Cells

As a young boy, I have always had an innate curiosity to understand the world around me. From my time […]