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Cervical lymphadenopathy can serve as a silent progressive indicator of systemic pathology and metastatic disease. Incidental or asymptomatic cervical lymphadenopathy can present a clinical dilemma when deciding on appropriate referral pathways and in specialist investigations. Metastasis to the head and neck may be more easily identified than locating the primary tumour site, which often requires a multitude of investigations to achieve an accurate diagnosis. As highlighted in this case report, primary care dentists play a central role in identification of patients with cervical lymphadenopathy who may require urgent specialist input in the context of subclavicular disease.
CPD/Clinical Relevance: This article highlights the clinical assessment of cervical lymphadenopathy and the investigatory tools used in secondary care to facilitate diagnosis.
Article
The COVID-19 pandemic continues to draw uncertainty with regard to identifying patients with undiagnosed cancer. The health crisis has been followed by significant reductions in urgent referrals from primary care, likely to be attributable to increased remote consulting, reduced face-to-face assessment and public fear resulting in patient reluctance to attend clinical settings. Approximately 12,000 new head and neck cancer diagnoses are made yearly in the UK, accounting for 3% of all new cancer cases.1 Data from England in April 2020 compared to April 2019, showed a 60% decrease in the number of urgent cancer referrals and an 18% decline in the number of people commencing treatment following an urgent GP referral.2,3 Emergency department presentations in England also decreased by 57% in April 2020 compared to the same period in the previous year.2 Thus, as the pandemic evolves, there is an emerging clinical iceberg of undiagnosed cancers yet to present.
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