耳鼻咽喉科・頭頸部外科88巻11号

2016年10月発行

特集 頸部郭清術のNew Concept

《臓器別治療戦略》

原発不明頸部転移がん

著者： 森田真吉¹ 松浦一登¹

所属機関： ¹宮城県立がんセンター頭頸部外科

ページ範囲：P.822 - P.827

文献概要

POINT

●原発不明がんは除外診断名であり，第一に原発巣の検索を進める。

●転移病巣が頸部リンパ節への扁平上皮癌の転移であることが証明された症例では，原発巣が頭頸部領域である可能性が高い。

●一次治療後の経過観察中に原発巣病変が10〜30％程度出現してくるが，そのうち約80％の症例が扁桃もしくは舌根部に由来する。

●HPV陽性中咽頭がんが増加しており，臨床的には原発不明がんの様相を呈しやすい。

●NBI内視鏡の積極的な活用が，原発巣の発見に寄与する可能性がある。

●切除が可能である場合は，根治治療と診断を兼ねた頸部郭清術が広く行われている。一方切除不可能な場合は，放射線療法もしくは化学放射線療法が考慮される。

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