Two thirds of patients with local disease will develop regional nodal metastases. Since there are no useful, reliable factors to determine the relative risk of regional metastases, all patients are considered at high risk. Sentinel lymph node excision gives less morbidity than total lymphadenectomy. Fine needle aspiration may be used preoperatively. The extent of regional disease and adherence to underlying structures is determined.
Treatment includes total lymphadenectomy and postoperative radiotherapy.
Patients with positive sentinel nodes have micrometastatic regional disease and are classified as pathologic stage II disease. They are further treated with total lymphadenectomy and postoperative radiotherapy to the regional site. Systemic Disease Clinical stage III disease may present in the bone, abdomen, skin, mediastinum, lung, or liver. The median survival is eight months. No firmly established chemotherapy for NEC exists.