Metastatic carcinoma of the neck of unknown primary origin

Cysts of the Neck, Unknown Primary Tumor, and Neck Dissection

“…172 The 5-year estimated survival rates for patients who undergo surgery of the neck for local tumor control are 69% to 100% (N1), 50% to 58% (N2), and 8% to 30% (N3). 171 The proportion of patients in whom the primary tumor is detected within 5 years of initial treatment has decreased from 30% in studies published between 1957 and 1973 258,[260][261][262] to approximately 10% in studies published since 1990. [263][264][265] This is probably the result of a more vigorous search for primary tumors, facilitated by improved diagnostic technologies.…”

“…169 Almost 50% of these primary tumors are located in the region of Waldeyer's tonsillar ring. 171,172,175,260,261 Below the clavicle, the largest numbers of primary tumors are found in the lungs and gastrointestinal tract. 169,175,181 According to most authors, the incidence of primary tumor identification after initial treatment of neck nodes is lower in patients who undergo radiotherapy than in those who do not.…”

The Occult Primary Tumor

“…The Search for the Primary Tumor At University of Michigan Medical Center, the following is considered the complete sequence of evaluation in the work-up of a neck mass with some variation depending upon the individual presentation of a given patient: (1) a careful history and gen¬ eral physical examination; (2) com¬ plete visualization as well as palpa¬ tion of the buccal cavity, base of the tongue, hypopharynx, and nasophar¬ ynx; (3) chest x-ray, sinus x-ray, and soft-tissue x-ray films of the neck and contrast studies of the upper gas¬ trointestinal tract and colon; (4) in¬ travenous pyelogram; (5) radioactive thyroid and salivary scans; (6) sialogram; (7) laryngoscopy, bronchoscopy, and esophagoscopy with selected biopsies; (8) needle biopsy in certain instances, but open biopsy preferred; (9) open biopsy with frozen section and neck dissection if indicated.…”

Occult primary carcinomata

“…Other studies of this type have been reported in the American literature. Acquarelli et al (1961) reports thirty-one cases with four well and 50 per cent dead in 8 months, three of those alive had excision and one excision followed by radiotherapy. France and Lucas (1963), however, in fortythree cases has four well and finds radiotherapy alone better than surgery followed by radiotherapy.…”