Differential Diagnosis
Squamous cell carcinoma (SCC) of the head and neck is the most common malignancy (90%) of the upper aerodigestive tract. Less common malignancies include melanoma, sarcoma, lymphoma and oral metastases.
Tests generally appear in the order most useful for common clinical situations
| Test name: Human Papillomavirus (HPV) Panel by in situ Hybridization, Paraffin |
| ARUP #: 2002893 |
| Methodology: In situ Hybridization |
| Use: Use for oropharyngeal carcinomas; indicative of better prognosis |
| Test name: Squamous Cell Carcinoma Antigen, Serum |
| ARUP #: 0081054 |
| Methodology: Quantitative Enzyme-Linked Immunosorbent Assay |
| Use: May be used sequentially (pre- and post-surgery) to follow tumor progression (increasing SCC antigen concentrations are associated with tumor stage progression) |
| Limitations: Elevated in patients with a variety of cancers Not intended for use in diagnosis Normally present in saliva, sweat, and respiratory secretions; precautions must be taken to prevent sample contamination with these fluids |
| Follow-up: In cases where elevated or increased SCC antigen concentrations are observed, retesting of a new sample is indicated to exclude contamination |
| Test name: EGFR Gene Amplification by FISH |
| ARUP #: 0049234 |
| Methodology: Fluorescence in situ Hybridization |
| Use: May be a prognostic marker; may also be useful in establishing treatment regimen |
| Limitations: Role in management of head and neck SCCs not well established |
| Test name: ERBB2 (HercepTest®) with Reflex to ERBB2 (HER-2/neu) Gene Amplification by FISH if 2+ or 3+ |
| ARUP #: 0049172 |
| Methodology: Immunohistochemistry |
| Use: May be associated with improved prognosis |
| Test name: Epstein-Barr Virus, Quantitative PCR |
| ARUP #: 0051352 |
| Methodology: Quantitative Polymerase Chain Reaction |
| Use: Monitor disease progression |
| Test name: Epstein-Barr Virus (EBV) By in situ Hybridization, Paraffin |
| ARUP #: 2002902 |
| Methodology: In situ Hybridization |
| Use: Use for nasopharyngeal carcinoma |
| Test name: p16 by Immunohistochemistry |
| ARUP #: 2004064 |
| Methodology: Immunohistochemistry |
| Use: Histologic prognosticator for oropharyngeal carcinomas; indicative of better prognosis |
| Test name: Lipid Associated Sialic Acid |
| ARUP #: 0080467 |
| Methodology: Quantitative Spectrophotometry |
| Comments: Use in conjunction with other tumor marker tests in managing select cancer patients (head and neck cancer, gynecological cancer, brain cancer, colorectal cancer and melanoma) |