Abstract
Squamous cell carcinoma of unknown primary (SCCUP) is a challenging diagnostic subgroup of oropharyngeal squamous cell carcinoma (OPSCC). The incidence of SCCUP is increasing in parallel with the well-documented increase in OPSCC and is likewise driven by the increase in human papillomavirus (HPV). The SCCUP patient often presents with a cystic lymph node metastasis and undergoes an aggressive diagnostic and treatment program. Detection of HPV in cytologic specimens indicates an oropharyngeal primary tumor origin and can guide the further diagnostic strategy. Advances in diagnostic modalities, e.g., transoral robotic surgery and transoral laser microsurgery, have increased the successful identification of the primary tumor site in HPV-induced SCCUP, and this harbors a potential for de-escalation treatment and increased survival. This review provides an overview of HPV-induced SCCUP, diagnostic modalities, and treatment options.
Highlights
A subgroup of oropharyngeal squamous cell carcinoma (OPSCC) is seen among patients referred with a cervical lymph node metastasis as the primary symptom of malignant disease and where the primary tumor site cannot be identified, named squamous cell carcinoma of unknown primary (SCCUP)
The aim of this review is to provide an overview of human papillomavirus (HPV)-induced SCCUP, including diagnostic workup strategies for the primary tumor and different treatment options in HPV-induced SCCUP patients
A large Danish cohort study observed a significant rise in palatine tonsil and base of tongue cancers from 2000 to 2017, and the surge in base of tongue cancers is speculated to be originating from increased use of transoral robotic surgery (TORS) tongue-base mucosectomy in patients with
Summary
A subgroup of OPSCC is seen among patients referred with a cervical lymph node metastasis as the primary symptom of malignant disease and where the primary tumor site cannot be identified, named squamous cell carcinoma of unknown primary (SCCUP). If the diagnostic workup fails to identify the primary tumor site, the patient is diagnosed with and subsequently treated for SCCUP. IMRT radiotherapy of the neck with total mucosal irradiation [8,11,12] This may lead to a successive quality of life (QoL) decline in domains such as xerostomia, dysphagia, and chewing ability, as demonstrated among OPSCC patients [13,14,15,16]. The aim of this review is to provide an overview of HPV-induced SCCUP, including diagnostic workup strategies for the primary tumor and different treatment options in HPV-induced SCCUP patients
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