Head and Neck Cancer with Lung Metastases: Treatment Challenges

Abstract

Head and neck cancer has predilection of metastasising to the lung, bones or liver. The site of metastasis usually depends on the primary tumour location, the staging and the regional spread of the tumour. Patients with distant metastasis are predicted to have a poor prognosis with low survival rate. Oligometastasis is the term used for an intermediate biologic state of restricted metastatic capacity with limited number and sites of organ with metastasis. It is also defined by 5 or less than 5 metastatic lesion in a disease with a controlled primary tumour.In this case series, we have reported three cases of head and neck carcinomas that pose treatment dilemmas because of lung metastases. First case is a gentleman with laryngeal carcinoma with multiple small lung metastases where the treatment options of surgery versus chemoradiation was debated. The second case is a gentleman with low grade mucoepidermoid carcinoma of the parotid gland with suspicious lung spread of disease. Lastly is a patient with papillary thyroid carcinoma with florid lung metastases who completed chemoradiation.The presence of lung metastases does not necessarily mean that the prospect of surviving is poor for the patient. It is necessary to determine the best choice of treatment yielding the best quality of life to maximize the survival period for these patients.