1) diagnosis.
I want to confirm whether the "neck lymph nodes" mentioned by netizens are really "neck" or refer to the lymph nodes in the supraclavicular fossa. The two will be different, which will affect the clinical thinking direction of doctors.
UPM in head and neck is indeed squamous cell carcinoma, especially poorly differentiated squamous cell carcinoma. The primary lesions are mainly concentrated in the head and neck: nasopharynx, oropharynx, larynx, parotid gland, tonsil, thyroid gland and so on.
Considering that patients still have mediastinal lymph node metastasis, lung cancer, mediastinal tumor, esophagus and stomach should also be considered.
However, if there is no tumor below the abdomen, the main lesion will not be below the chest.
I believe that the hospital will conduct the above-mentioned diagnosis and investigation on patients one by one.
There are two possibilities for not finding the lesion:
A) The primary lesion is very small. (subclinical lesion)
B) The primary lesion disappeared after the formation of metastatic carcinoma.
If conventional imaging examination (X-ray, CT, MRI) can't confirm the diagnosis, the most advanced examination method is PET-CT. This kind of examination is very expensive, about 1 time 1 ten thousand, and it is only carried out in top hospitals in some big cities. If the patient has a good economy and a positive desire for diagnosis and treatment, this examination is worth doing. Of course, even if you do, it will only give you another chance to be diagnosed. If you can't pay, you will definitely have a positive result.
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2) treatment.
The patient's hoarseness is a very bad signal, which is generally a manifestation of local late stage or even systemic late stage. If the symptoms of hoarseness are allowed to develop and the superior vena cava compression syndrome appears, the patient will have a hard time. Therefore, at present, appropriate radiotherapy is carried out to relieve symptoms and prevent serious late symptoms. I am very much in favor of this treatment. Of course, because all of them have had radiotherapy, it will be better if radiotherapy is given to the drainage area of cervical lymph nodes by the way.
In addition, radiotherapy alone is not enough. After proper radiotherapy and curative effect, chemotherapy should be considered at an appropriate time. Kill tumor lesions from the whole body.
I recommend that the best chemotherapy scheme is "paclitaxel plus cisplatin".
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The above opinions are based on the latest progress in diagnosis and treatment of metastatic squamous cell carcinoma with unknown primary focus. I regard it as a review and give help to netizens.
And I'm just treating a similar case (radiotherapy).