Cervical Metastasis from an Unknown Primary

Abstract

Summary--Forty-nine patients with cervical metastases from unknown primaries were treated during an 11-year period. Thirty-one (63%) of these patients were treated for cure rather than palliation. The three-year survival rate of these patients treated for cure was 39%. Although the treatment of these patients varied, a systematic mode of therapy has evolved: patients with histopathologic diagnosis of epidermoid carcinoma, or undifferentiated malignant tumor, metastatic to the neck from an unknown primary, are treated with full course radiation therapy (6000-7000 rads at 1000 rads per week). This is delivered to the nasopharynx, pyriform fossae, base of tongue, and the neck, and is followed by radical neck dissection in those patients in whom the neck nodes remain palpable. Six of the last 11 consecutive patients treated in this manner are long-term survivors. This paper describes the evaluation of patients with cervical metastases from unknown primaries as well as their therapy.

Tonsillectomy vs. deep tonsil biopsies in detecting occult tonsil tumors

“…With the recognition of the tonsil region as a significant site for primary tumors to emerge after treatment,9, 10 many subsequent series have included random biopsies of the tonsil as well. However, the overall yield of random biopsies in identifying occult primary tumor location was recognized to be quite low, ranging from 2% to 15% in patients without suspicious lesions on examination or radiography 17, 18…”

Occult tonsillar carcinoma in the unknown primary

“…2,4–7 Biopsies of the nasopharynx, base of tongue, and pyriform sinuses have routinely been advocated, since these sites are reported as the most prevalent areas to harbor the primary tumor in patients presenting with an unknown primary. 2,3,8 The yield from such directed biopsy specimens, however, has been consistently quite low, and identification of a primary tumor occurs in only 2% to 15% of specimens 6,9 …”

Metastatic squamous cell carcinoma neck with occult primary: A retrospective analysis

“…Large reported series indicated that the frequency is around 3% of the total head and neck cancer cases. [1–4] Owing to the rarity of the disease, all reports on treatment results of patients with squamous cell carcinoma of unknown primary tumor site presenting with cervical neck nodes are retrospective.…”

“…Metastasis of unknown primary on the whole carries a very poor prognosis, but in the head and neck region this is not the case. [1–4] The 5-year disease-specific survival rates range upwards to 74% in modern series, with overall survival rates being in the 40–66% range. [5–9]…”