Showing papers by "Kenneth O. Devaney published in 2008"

Detection of lymph node micrometastases in patients with squamous carcinoma of the head and neck.

Abstract: While the significance of large cervical node metastases in patients with head and neck squamous carcinomas is well established, the import of a finding of regional nodal micrometastases (where a micrometastasis is defined as a metastatic deposit greater than 0.2 mm and not greater than 2.0 mm in greatest dimension) or isolated tumor cells in those patients is less clearly understood. Some earlier investigators have suggested that finding micrometastases does not have an impact on prognosis; some later investigators, however, have taken issue with this position, arguing that finding either micrometastases or isolated tumor cells might portend a poorer prognosis for head and neck cancer patients. At this juncture, it is difficult to advance a single recommendation for handling a finding of micrometastases or isolated tumor cells. It would be helpful if two courses of action were followed: first, while the detection of micrometastases and isolated tumor cells remains an investigatory practice, data should be collected and analyzed with an eye to discerning whether such findings are indeed of significance to the individual head and neck cancer patient. Second, rigorous definitions of micrometastases and isolated tumor cells (such as the definitions suggested here) should be developed and widely employed so as to permit ready comparison between the results as they are reported by different investigators.

Can biomarkers play a role in the decision about treatment of the clinically negative neck in patients with head and neck cancer

Abstract: For most patients with head and neck squamous cell cancer, a treatment decision concerning the neck is required. Since detection of small metastases in lymph nodes is difficult, many of the patients with no detectable metastases receive elective treatment of the neck. Additional information on the metastatic potential of the primary tumor before treatment may be useful to reduce the number of these elective procedures. Biomarkers may supply such information. Molecules involved in several pathways have been studied, but the complexity of the metastatic process makes it unlikely that a single marker for metastasis can de identified. Techniques allowing the study of many factors simultaneously seem to be the most promising ones. In recent years, microarray expression profiling and comparative genomic hybridization studies have yielded interesting results. If these results can be confirmed in larger studies, they may play a role in future clinical decision making on treatment of the clinically N0 neck.

Squamous carcinoma arising in a branchial cleft cyst: have you ever treated one? Will you?

Abstract: The existence of primary branchiogenic carcinoma - that is, carcinoma arising in a pre-existing branchial cleft cyst (a benign developmental cyst) - has in recent decades been the subject of increasing scepticism. Recognition of the propensity of a variety of head and neck sites - including in particular the tonsil - to give rise to cervical metastases while the primary tumours themselves remain undetected has given rise to the idea that virtually all cystic carcinomas of the neck represent metastatic deposits, whether or not their primary sites are found. A diagnosis of primary branchiogenic carcinoma should be viewed with extreme scepticism, and every effort should be made (e.g. imaging, panendoscopy, elective tonsillectomy) to exclude the existence of a primary site elsewhere, before considering a diagnosis of primary branchiogenic carcinoma.