Head and neck carcinoma of unknown primary: diagnosis, management and treatment outcomes in 102 patients

Objectives The current study aimed to investigate the management of patients with suspicion of cancer of unknown primary (CUP) in the head and neck, to evaluate treatment outcomes and determine prognostic factors.

Methods 102 consecutive patients suspected of having CUP investigated in our tertiary ENT clinic within a 10-year period (2007-2017) were evaluated retrospectively. Patients received routine work-up consisting of CUP-panendoscopy, bilateral tonsillectomy and imaging including computer tomography scans of the neck-chest and an abdominal ultrasound. PET-CT scans were employed routinely since 2015.

Results After diagnostic work-up, a primary tumor was identified in 47 patients. In 55 patients the diagnosis of CUP was established. Mean age in the latter cohort was 64.3 years (38-87), with 49 males and 6 females. The most common histology was squamous cell carcinoma (SCC) in 45 patients (81.8 %). 47 had a unilateral cervical metastasis (85.5 %), 8 (15.5 %) a bilateral cervical metastasis and 11 a distant metastasis at the time of diagnosis. 7 patients were lost to follow-up. 48 patients were followed-up for a median time of 36.3 months (0.7-121.2) and the 5-year overall survival (OS) was 44.4 %. There were 32 patients with SCC and no distant metastasis. Their 5-year OS, 5-year disease-free survival (DFS) and 5-year local recurrence-free survival (LRF) was 56,2 %, 37,5 % and 50,4 % respectively. Patients who underwent surgical treatment with postoperative radiation/chemoradiation had a 5-year OS of 83 % compared to 26.9 % for those treated with surgery alone.

Conclusion In patients with CUP, survival outcomes are significantly influenced by clinical stage at time of diagnosis and treatment modality. In future, primary tumor detection rate may be improved by PET-CT scans.

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Publication History

Article published online:
10 June 2020