Neck Cancer With Unknown Primary Site Guidelines

Updated: Mar 04, 2021
  • Author: Philip E Zapanta, MD, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Guidelines Summary

United Kingdom

Guidelines from the United Kingdom on the workup and management of patients with metastatic neck cancer with an unknown primary site include the following recommendations [45] :

  • All patients presenting with confirmed cervical lymph node metastatic squamous cell carcinoma and no apparent primary site should undergo: (1) PET-CT whole-body scanning, (2) panendoscopy and directed biopsies, and (3) bilateral tonsillectomy
  • Tongue base mucosectomy can be offered if facilities and expertise exist
  • Concomitant chemotherapy with radiation should be considered in patients with an unknown primary
  • Concomitant chemotherapy with radiation should be offered to suitable patients in the postoperative setting, where indicated
  • Neoadjuvant chemotherapy can be used in gross “unresectable” disease
  • Patients should be followed up to a minimum of 5 years, with a prolonged follow-up for selected patients
  • PET-CT scanning at 3-4 months after treatment is a useful follow-up strategy for patients treated by chemoradiation therapy

French Society of Otorhinolaryngology and Head and Neck Surgery

Guidelines from the French Society of Otorhinolaryngology and Head and Neck Surgery include the following recommendations with regard to clinical and imaging assessment of cystic neck lymphadenopathy with unknown primary site [46] :

  • In adults with a lateral cervical mass with cystic aspect, clinical examination should include “inspection of head and neck teguments, otoscopy, head and neck mucosal examination with pharyngolaryngeal flexible endoscopy, and palpation of the tongue base and tonsils, thyroid and salivary glands and lateral and central cervical lymph-node areas”
  • With regard to ultrasonographic assessment of cystic neck lymphadenopathy without clear etiology, first-line cervical and thyroid ultrasonographic scanning should be performed, a high-frequency probe coupled to B-mode and Doppler should be employed, and ultrasonographically guided fine-needle aspiration of the lymph node and any suspicious thyroid nodule should be carried out
  • Evaluation of adults with cystic cervical neck lymphadenopathy with unknown primary site should be performed using contrast-enhanced head and neck and chest CT scanning
  • Primary detection using 18F-FDG PET/CT scanning should be performed in metastatic cystic lymphadenopathy of unknown primary site, “notably revealing oropharyngeal carcinoma”; the examination preferably should be carried out prior to pharyngeal biopsy