eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Head & Neck Surgery

Neck Cancer, Unknown Primary Site: Follow-up

Author: Philip E Zapanta, MD, Assistant Professor of Surgery, Associate Director of Otolaryngology Residency Program, Division of Otolaryngology-Head and Neck Surgery, George Washington University Medical Center; Consulting Staff, Division of Otolaryngology-Head and Neck Surgery, Medical Faculty Associates
Coauthor(s): Guy J Petruzzelli, MD, PhD, MBA, FACS, The Charles Arthur Weaver Professor of Cancer Research, Professor and Senior Attending Physician, Director of Head, Neck, and Skull Base Surgery, Department of Otolaryngology, Rush University Medical Center; Ahmed Mohyeldin, PhD, George Washington University School of Medicine and Health Sciences, Washington, DC; Jeremy B White, MD, Resident Physician, Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC
Contributor Information and Disclosures

Updated: Mar 12, 2009

Outcome and Prognosis

Patients with metastatic squamous cell carcinoma of the head and neck from occult primary lesions have clinical features and prognosis similar to those patients with carcinoma from known primary sites. With multimodality treatment, locoregional control of the cancer has improved in this patient population, but little improvement has occurred in overall disease-free survival. The 3- and 5-year disease-free survival rates are 40-60% and 10-25%, respectively. Prognostic factors include nodal stage at presentation, extracapsular spread, and tumor differentiation.23,24,28

Future and Controversies

The treatment of cervical lymphadenopathy from metastatic squamous cell carcinoma with an occult primary lesion is in flux. Large institutional studies are currently evaluating the efficacy of chemoradiation therapy as the sole treatment modality. This treatment regimen will be compared against the traditional combined modality treatment of neck dissection followed by radiation and/or chemotherapy.

In addition to comparing different treatment modalities, advances in science allow the use of oncogenes and microarray complementary deoxyribonucleic acid (cDNA) technology to determine which patients will respond to specific treatments.

 


More on Neck Cancer, Unknown Primary Site

Overview: Neck Cancer, Unknown Primary Site
Workup: Neck Cancer, Unknown Primary Site
Treatment: Neck Cancer, Unknown Primary Site
Follow-up: Neck Cancer, Unknown Primary Site
Multimedia: Neck Cancer, Unknown Primary Site
References
[ CLOSE WINDOW ]

References

  1. Jereczek-Fossa BA, Jassem J, Orecchia R. Cervical lymph node metastases of squamous cell carcinoma from an unknown primary. Cancer Treat Rev. Apr 2004;30(2):153-64. [Medline].

  2. Wenig BM. Neoplasms of the nasal cavity and paranasal sinuses. In: Wenig BM, ed. Atlas of Head and Neck Pathology. Philadelphia: WB Saunders Co; 1993:29-39.

  3. Mendenhall WM, Mancuso AA, Parsons JT, Stringer SP, Cassisi NJ. Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site. Head Neck. Dec 1998;20(8):739-44. [Medline].

  4. Termine N, Panzarella V, Falaschini S, et al. HPV in oral squamous cell carcinoma vs head and neck squamous cell carcinoma biopsies: a meta-analysis (1988-2007). Ann Oncol. Oct 2008;19(10):1681-90. [Medline].

  5. Davidson BJ, Harter W, OMalley BB. Cervical lymph node metastasis from squamous cell carcinoma with unknown primary site. In: Harrison LB, Sessions RB, Hong WK, eds. Head and Neck Cancer-Multidisciplinary Approach. NY: Lippincott-Raven; 1999:391-410.

  6. Simo R, OConnell M. Metastatic squamous cell carcinoma of occult primary: beware the tonsillar remnant. J Laryngol Otol. Jun 2008;122(6):641-3. [Medline].

  7. Schmalbach CE, Miller FR. Occult primary head and neck carcinoma. Curr Oncol Rep. Mar 2007;9(2):139-46. [Medline].

  8. Savoury LW, Glckman JL. Cervical metastasis. In: Paparella MM, Shumrick DA, Myeroff WL, eds. Otolaryngology. 3rd ed. Philadelphia: WB Saunders Co; 1991:2565-2568.

  9. Robbins KT, Clayman G, Levine PA, et al. Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. Arch Otolaryngol Head Neck Surg. Jul 2002;128(7):751-8. [Medline].

  10. DeSanto LW, Neel HB 3rd. Squamous cell carcinoma. Metastasis to the neck from an unknown or undiscovered primary. Otolaryngol Clin North Am. Aug 1985;18(3):505-13. [Medline].

  11. Neel HB 3rd, Pearson GR, Weiland LH, Taylor WF, Goepfert HH. Immunologic detection of occult primary cancer of the head and neck. Otolaryngol Head Neck Surg. Mar-Apr 1981;89(2):230-4. [Medline].

  12. Feinmesser R, Miyazaki I, Cheung R, Freeman JL, Noyek AM, Dosch HM. Diagnosis of nasopharyngeal carcinoma by DNA amplification of tissue obtained by fine-needle aspiration. N Engl J Med. Jan 2 1992;326(1):17-21. [Medline].

  13. Zhang MQ, El-Mofty SK, Davila RM. Detection of human papillomavirus-related squamous cell carcinoma cytologically and by in situ hybridization in fine-needle aspiration biopsies of cervical metastasis: a tool for identifying the site of an occult head and neck primary. Cancer. Apr 25 2008;114(2):118-23. [Medline].

  14. Brouwer J, de Bree R, Hoekstra OS, et al. Screening for distant metastases in patients with head and neck cancer: is chest computed tomography sufficient?. Laryngoscope. Oct 2005;115(10):1813-7. [Medline].

  15. McCabe KJ, Rubinstein D. Advances in head and neck imaging. Otolaryngol Clin North Am. Apr 2005;38(2):307-19, vii. [Medline].

  16. Dillon WP, Harnsberger HR. The impact of radiologic imaging on staging of cancer of the head and neck. Semin Oncol. Apr 1991;18(2):64-79. [Medline].

  17. Regelink G, Brouwer J, de Bree R. Detectin of unknown primary tumours and distant metastases in patients with cervical metastases: value of FDG-PET versus conventional modalities. European Journal of Nuclear Medicine & Molecular Imaging. 2002;29:1024-30.

  18. Miller FR, Hussey D, Beeram M, Eng T, McGuff HS, Otto RA. Positron emission tomography in the management of unknown primary head and neck carcinoma. Arch Otolaryngol Head Neck Surg. Jul 2005;131(7):626-9. [Medline].

  19. Jungehulsing M, Scheidhauer K, Damm M, et al. 2[F]-fluoro-2-deoxy-D-glucose positron emission tomography is a sensitive tool for the detection of occult primary cancer (carcinoma of unknown primary syndrome) with head and neck lymph node manifestation. Otolaryngol Head Neck Surg. Sep 2000;123(3):294-301. [Medline].

  20. Greven KM, Keyes JW Jr, Williams DW 3rd, McGuirt WF, Joyce WT 3rd. Occult primary tumors of the head and neck: lack of benefit from positron emission tomography imaging with 2-[F-18]fluoro-2-deoxy-D-glucose. Cancer. Jul 1 1999;86(1):114-8. [Medline].

  21. Zanation AM, Sutton DK, Couch ME, Weissler MC, Shockley WW, Shores CG. Use, accuracy, and implications for patient management of [18F]-2-fluorodeoxyglucose-positron emission/computerized tomography for head and neck tumors. Laryngoscope. Jul 2005;115(7):1186-90. [Medline].

  22. Jesse RH, Perez CA, Fletcher GH. Cervical lymph node metastasis: unknown primary cancer. Cancer. Apr 1973;31(4):854-9. [Medline].

  23. Grau C, Johansen LV, Jakobsen J, Geertsen P, Andersen E, Jensen BB. Cervical lymph node metastases from unknown primary tumours. Results from a national survey by the Danish Society for Head and Neck Oncology. Radiother Oncol. May 2000;55(2):121-9. [Medline].

  24. Maulard C, Housset M, Brunel P, et al. Postoperative radiation therapy for cervical lymph node metastases from an occult squamous cell carcinoma. Laryngoscope. Aug 1992;102(8):884-90. [Medline].

  25. Argiris A, Smith SM, Stenson K, et al. Concurrent chemoradiotherapy for N2 or N3 squamous cell carcinoma of the head and neck from an occult primary. Ann Oncol. Aug 2003;14(8):1306-11. [Medline].

  26. Randall DA, Johnstone PA, Foss RD, Martin PJ. Tonsillectomy in diagnosis of the unknown primary tumor of the head and neck. Otolaryngol Head Neck Surg. Jan 2000;122(1):52-5. [Medline].

  27. Kothari P, Randhawa PS, Farrell R. Role of tonsillectomy in the search for a squamous cell carcinoma from an unknown primary in the head and neck. Br J Oral Maxillofac Surg. Jun 2008;46(4):283-7. [Medline].

  28. Huang CC, Tseng FY, Yeh TH, et al. Prognostic factors of unknown primary head and neck squamous cell carcinoma. Otolaryngol Head Neck Surg. Sep 2008;139(3):429-35. [Medline].

  29. Al-Sarraf M, LeBlanc M, Giri PG, et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol. Apr 1998;16(4):1310-7. [Medline].

  30. de Braud F, al-Sarraf M. Diagnosis and management of squamous cell carcinoma of unknown primary tumor site of the neck. Semin Oncol. Jun 1993;20(3):273-8. [Medline].

  31. Koch WM, Bhatti N, Williams MF, Eisele DW. Oncologic rationale for bilateral tonsillectomy in head and neck squamous cell carcinoma of unknown primary source. Otolaryngol Head Neck Surg. Mar 2001;124(3):331-3. [Medline].

  32. Miller FR, Karnad AB, Eng T, Hussey DH, Stan McGuff H, Otto RA. Management of the unknown primary carcinoma: long-term follow-up on a negative PET scan and negative panendoscopy. Head Neck. Jan 2008;30(1):28-34. [Medline].

  33. Cancer of the Unknown Primary Site. In: Petruzzelli GJ. Practical Head and Neck Oncology. San Diego: Plural Publications; 2009:385-412.

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

neck cancer, head and neck cancer, head neck cancer, cancer, cancer diagnosis, fine-needle aspiration, head and neck cancer unknown primary, metastatic cervical lymphadenopathy, occult primary squamous cell carcinoma of the head and neck, unknown primary carcinoma, metastatic squamous cell carcinoma, unknown primary cancer

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Philip E Zapanta, MD, Assistant Professor of Surgery, Associate Director of Otolaryngology Residency Program, Division of Otolaryngology-Head and Neck Surgery, George Washington University Medical Center; Consulting Staff, Division of Otolaryngology-Head and Neck Surgery, Medical Faculty Associates
Philip E Zapanta, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, Christian Medical & Dental Society, and Medical Society of the District of Columbia
Disclosure: Nothing to disclose.

Coauthor(s)

Guy J Petruzzelli, MD, PhD, MBA, FACS, The Charles Arthur Weaver Professor of Cancer Research, Professor and Senior Attending Physician, Director of Head, Neck, and Skull Base Surgery, Department of Otolaryngology, Rush University Medical Center
Guy J Petruzzelli, MD, PhD, MBA, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Association for the Advancement of Science, American Association of Clinical Anatomists, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, American Society of Clinical Oncology, Chicago Medical Society, North American Skull Base Society, Society of Surgical Oncology, Society of University Otolaryngologists-Head and Neck Surgeons, and Southwest Oncology Group
Disclosure: Nothing to disclose.

Ahmed Mohyeldin, PhD, George Washington University School of Medicine and Health Sciences, Washington, DC
Disclosure: Nothing to disclose.

Jeremy B White, MD, Resident Physician, Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC
Jeremy B White, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Benoit J Gosselin, MD, FRCSC, Associate Professor of Surgery, Dartmouth Medical School; Director, Comprehensive Head and Neck Oncology Program, Norris Cotton Cancer Center; Staff Otolaryngologist, Division of Otolaryngology-Head and Neck Surgery, Dartmouth-Hitchcock Medical Center
Benoit J Gosselin, MD, FRCSC is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, American Medical Association, American Rhinologic Society, Canadian Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, College of Physicians and Surgeons of Ontario, New Hampshire Medical Society, North American Skull Base Society, and Ontario Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Nader Sadeghi, MD, FRCS(C), Associate Professor of Surgery, Director of Head and Neck Surgery, Division of Otolaryngology, George Washington University
Nader Sadeghi, MD, FRCS(C) is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, Federation of Medical Specialists in Quebec, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.