Initial staging of squamous cell carcinoma of the oral cavity, larynx and pharynx (excluding nasopharynx). Part 2: Remote extension assessment and exploration for secondary synchronous locations outside of the upper aerodigestive tract. 2012 SFORL guidelines

Eur Ann Otorhinolaryngol Head Neck Dis. 2013 Apr;130(2):107-12. doi: 10.1016/j.anorl.2012.09.003. Epub 2012 Dec 28.


Objectives: This report presents the French Society of ORL (SFORL) guidelines for exploration for remote metastasis and synchronous second cancer in initial staging of head and neck squamous cell carcinoma.

Materials and methods: An exhaustive literature review was analyzed by a multidisciplinary work-group.

Results: The thorax is the most frequent location of remote metastases and synchronous second cancer outside of the upper aerodigestive tract. Thoracic CT is recommended as first-line examination in all cases (grade B). 18-FDG PET/CT is recommended when the thoracic CT image is doubtful or in case of high metastatic risk (grade B), for the detection of non-pulmonary remote metastasis. Esophageal exploration is recommended in case of significant risk of synchronous esophageal cancer (hypopharyngeal or oropharyngeal tumor, chronic alcohol intoxication) (grade B). The reference examination is flexible endoscopy of the upper digestive tract (grade B).

Conclusion: The present grade B recommendations rationalize the roles of the various first-line radiological and endoscopic examinations for remote metastasis and synchronous second cancer, so as to limit the number of examinations performed, thereby reducing the time needed for initial staging.

Publication types

  • Practice Guideline

MeSH terms

  • Alcohol Drinking / adverse effects
  • Bronchial Neoplasms / pathology
  • Bronchial Neoplasms / secondary
  • Carcinoma, Squamous Cell / pathology*
  • Carcinoma, Squamous Cell / secondary*
  • Endoscopy
  • Esophageal Neoplasms / pathology
  • Esophageal Neoplasms / secondary
  • Humans
  • Laryngeal Neoplasms / pathology*
  • Lung Neoplasms / pathology
  • Lung Neoplasms / secondary
  • Magnetic Resonance Imaging
  • Mouth Neoplasms / pathology*
  • Neoplasm Metastasis
  • Neoplasm Staging
  • Neoplasms, Second Primary / pathology*
  • Pharyngeal Neoplasms / pathology*
  • Positron-Emission Tomography
  • Risk Factors
  • Smoking / adverse effects
  • Thoracic Neoplasms / secondary*
  • Tomography, X-Ray Computed