5、小结
目前UPCMC原发灶的检测还是以传统的检查方法为主，强调注意转移癌的病理形态学特征和生化指标检测结果，注意转移癌的解剖部位，对鼻咽、鼻腔的检查应注意肉眼检查与影像学检查相结合;全内镜检查和随机活检在一定程度上提高了原发灶的检出率;FDG PET在UPCMC原发灶的检测中有一定的帮助，但确切的应用价位还有待进一步研究;LIF和基因检测的研究目前仍处于起步阶段，但从现有的报道却预示着其令人乐观的应用前景。近期观点认为,应根据转移灶的部位,病灶大小，N分期,病理类型来选择合理的治疗方式,主要包括放疗,手术,化疗以及其中两种或三种联合的综合治疗。
【参考文献】
[1]Randall DA ,Johnstone PA, Foss RD ,et al .Tonsillectomy in diagnoses of unknown primary tumor of the head and neck [J].Otolaryngol head neck surg ,2000,122(1):52-55.
[2]Grau C,Johansen LV ,Jackobsen J ,et al .Cervical lymph node metastases from unknown primary tumorours .Results from a national survey by the Danish Society for head and neck Oncology[J].Radiother Oncol ,2000,55(2):121-129
[3]Abbruzzese JL, Abbruzzese MC，Lenzi R,et al . Analysis of a diagnostic strategy for patients with suspected tumor of unknown origin [J].J Clin Oncol ,1995,13(8):2094-2103
[4]N guyen C, Metastatic squamous cell carcinoma to cervical lymph nodes from unknown primary mucosal site Head Neck,1994.16(1):58-62
[5]Lefebvre JI ,Bermard CD, Van JT , et al . Cervical lymph nodes from unknown primary tumor in 190 patients ,Am J Surge,1990.160(4) :443-446
[6]Le-Chevalier T ,Cvitkovic E ,Caille P ,et al .Early metadtatic cancer of unknown primary origin at presentation.A clinical study of 302 consecutive autuopsied patients [J].Arch Intern Med ,1998,148:2035-2039
[7]Mayordomo JI, Guerra JM, Guijarro C, et al .Neoplasms of unknown primary site :a clinnicopathological study of autopsied patients [J].Tumori ,1993,79(5):321-324
[8]Davidson BJ ,Harter W ,O’Malley BB .Cervical lymph node metastasis from squamous cell carcinoma with unknown primary site [M].In :Thawley SE, Panje WR ,Batskis JG, et al .Comprehensive management of head and neck tumors .2nd ed. Phiadephia: Saunders, 1999.:391-409
[9]Msckay B, Ordonez NG. Pathological evaluation of neoplasms with unknown primary tumor site[J].Semin Oncol, 1993,20(3):206-228.
[10]Righi PD ,Sofferman RA .Screening unilateral tonsillectomy in the unknown primary [J].Laryngoscoe, 1995,105:548-550.
[11]Reiter ER, Randolph GW, Pilch BZ, et al .Microscopic detection of occult malignancy in the adult tonsil[J].Otolaryngol Head Neck Surg, 1999,120(2):190-194.
[12]Lapeyre M, Malissard L. Peiffert D ,et al .Cervical lymph node metastasis from an unknown primary :Is a Tonsillectomy necessary?[J].Int J Radiat Oncol Biol Phys, 1990,19(4):1101-1102.
[13]Keyes JW, Waston NE, Williams DW, et al .FDG PET in head and neck cancer[J].AJR Am J Roentgenol, 1997,169(6):1663-1669.
[14]Assar OS, Fischbein NJ, Caputo GR, et al .Metastatic head and neck cancer :role and usefulness of FDG PET in locating occult primary tumors[J].Radiology,1999,210(1):177-181.
[15]Lassen U, Daugaard G, Eigtved A, et al.18F-FDG whole body positron emission tomography(PET) in patients with unknown primary tumors(UPT)[J].Eur J Cancer, 1999,35(7):1076-1082.
[16]Greven KM, Keyes JW Jr, Williams DW, et al .Occult primary tumors of the head and neck: lack of benefit from positron emission tomography imaging with 2-[F-18] fluoro-2-deoxy-D-glucose[J].cancer, 1999,86(1):114-118.
[17]Kulapaditharom B, Boonkitticharoen V, Kunachak S, Fluorescence-guided biopsy in the diagnosis of an unknown primary cancer in patients with metastatic cervical lymph nodes[J].Ann Otol Rhinol Laryngol ,1999,108(7 Pt 1):700-704.
[18]Califano J , Westra WH, Koch W, et al .Unknowm primary head and neck squamous cell carcinoma: molecular identification of the site of origin[J].J Natl Cancer Inst, 1999,91(7):599-604.
[19]肖光丽,徐国镇,高黎.原发不明的颈部淋巴结转移癌的治疗.中华放射肿瘤学杂志, 2000, 11(2): 84~87
[20]殷玉林,唐平章,徐国镇等.颈部原发不明转移癌的治疗与转归.中华肿瘤杂志, 1999, 21(3): 230~232
[21]Davidson BJ,Spiro RH,Patel S,et al.Cervical metastases of occult origin:the impact of combined modality therapy[J].Am J Surg,1994,168(4):395~399·
[22]Templer J, Perry MC, Davis W E. Metastatic cervical adenocarcinoma from unknown primary tumor. Arch O tola ryng, 1981, 107(1): 45~47
[23]Nguyen C.Metastatic squamous cell carcinoma to cervical lymph nodes from unkown primary mucosal sites[J].Head Neck,1994,16(1):58~63·
[24]Reddy SP,Marks JE.Metastatic carcinoma in the cervical lymph nodes from an unknown primary site:results of bilateral neck plus mucosal irradiation[J].Int J Radiat Oncol Biol Phys,1997,37(4):797~802·
