근원불명의 원발성경부암에 관한 임상적 고찰

Abstract

[한글]

경부전이암에 관한 문제는 역사적으로 그 근원암(Primary cancer) 및 전이암(metastatic cancer)의 치료방법에 있어서 많은 논란의 대상이 되어 왔다. 대부분의 경우 정밀한 이학적 소견만으로도 그것의 근원을 증명할 수 있으나 때로는 환자의 과거력, 자각증상, 종괴의 위치 및 양상, 특수 X-선 검진 및 병리조직학적 소견을 동원하여도 근원암을 규명하지 못하는 경우가 있다. 저자는 1967년 3월부터 1976년 3월까지 만10년간 연세의료원에서 치험한 경부전이암환자 427예중 임상적으로 근원을 증명할 수 없었던 74예를 대상으로 임상적결과를 분석 검토하고 이에 문헌고찰과 아울러 보고하는 바이다.

1) 연령별 발생분포는 50대에서 가장 많았고 남녀의 비는 1.7:1이었다.

2) 종괴의 크기는 3cm이상이 대부분이었고 위치는 submaxillary, subdigastric 및 supraclavicular node가 대부분 이었다.

3)병리조직학적 소견은 squamous cell type이 가장 많았고 adenocarcinoma, anaplastic cell의 순이었다.

4) 병리조직학적 소견으로 경부종괴로부터 근원이 증명된 것은 갑상선 13예, 타액선 4예 이었으며 6예에서는 외래에서 추적되어 근원이 증명되었거나 Disseminated cancer로 나타났으며 그밖에 추적을 통하여 근황을 알 수 있었던 12예를 포함하면 18예에서 추적이

가능하였다.

5) 어떠한 방법으로도 근원을 증명할 수 없었던 51예의 환자에서 치료방식은 Radical Neck Dissection 9예, Radiation 13예, Radical Neck Dissection 및 Radiation을 복합하여 시행하였던 경우가 5예, 화학요법을 시행한 경우가 6예 이었다.

[영문]

The subject of cervical metastatic cancer is considered of significance from the standpoints of treatment and prognosis alone, since the average physician regards metastasis as a secondary or late symptom found only in association with a readily demonstrable primary growth.

Guidelines for the optimal management of patients with cervical cancer associated with an unknown primary lesion were outlined in 1966 by Jesse.

But certain authors favor an operative approach primarily, while others prefer a radiotherapeutic approach. Other groups suggest various combinations of operation and radiotherapy as the best treatment.

All patients with cervical lymph node metastasis from an unknown primary tumor do not present identical situation with respect to diagnosis and treatment.

A patient with single, small, mobile node in the subdigastric area, or one in whom all palpable disease has been removed at the time of biopsy, does no present the same therapeutic problem as one with multiple ipsilateral or bilateral nodes. The latter situations represent a considerably more difficult problem in control. Similarly, supraclavicular lymph node involvement is associated with a poorer prognosis than is upper cervical nodal involvement.

Author reviewed the patients with cervical metastatic caner, who were admitted and treated in Yonsei Medical Center during the period between 1967 and 1976, and evaluated clinical patterns, proper management and follow-up for which no primary lesion could be determined clinically at the time of initial treatment.

The following results were obtained,

1. The age distribution was peak in sixth decade and male to female ratio was 1.7:1.

2. Eighty four percent of the patients in this study had been aware of a neck mass or masses for six to twelve months or less.

3. The size of metastatic deposit or node was measured between 1 and 12 cm. in diameter, and half of these were less than 3 cm .

4. Metastasis predominated overwhelmingly in submaxillary, subdigastric and supraclavicular nodes.

5. Histological diagnosis had been obtained by previous excisional biopsy in all of 74 patients, whose cervical metastasis were the first symptom of cancer.

6. Primary cancer were confirmed in 17 of 74 patients either by biopsy of follow-up; 17 patients were confirmed by excisional biopsy alone and in 6 patients, primary cancer was found during follow-up as disseminated cancer. Therefore 12 percent (51 of 427) of patients in this study might be categorized as occult neck cancer.

7. Squamous cell cancer was predominate and adenocarcinoma, anaplastic cancer in order.

8. Nine patients underwent radical neck dissection, and thirteen patients received radiation therapy, and five patients were treated by surgery and radiation, and 6 patients by chemotherapy alone.