No standard protocol is universally accepted, largely because clinical trials involve small cohorts in which the variety of clinical presentations is tremendous. Some of the most commonly used agents are paclitaxel and cisplatinum or carboplatinum. Other popular agents include etoposide and ifosfamide. Surgical and radiation therapies are reserved for specific circumstances. For instance, surgery might be indicated as palliation of tumor bulk or, as in our patient, resolution of a complication if metastasis.
Surgery is also an option in cases of squamous cell carcinoma presenting in cervical lymp nodes.
A tumor in the upper respiratory tract can be assumed, and a radical neck dissection is the treatment of choice. Similarly, women with axillary adenopathy often undergo bilateral modified radical mastectomy. Radiation therapy is indicated after radical neck dissection or after axillary lymph node dissection in lieu of mastectomy. As with all metastatic disease, treatment is of purely palliative benefit for most patients. The extreme toxicity of many chemotherapy protocols and potential complications of any therapy modalities may discourage some patients from accepting treatment.