Cervical lymph node metastasis from an unknown primary site

Approximately 10% of lymph node metastases in head and neck region lack primary site source. In ¾ of the cases, with further diagnostics, a primary site can be located in head and neck region due to the cervical lymph node drainage. Sometimes the tumor cells of the primary site can bypass the nearest lymph nodes and metastasize further away. That leads to diagnostic problems which hinders the full capacity of patient health care.

The authors present their experience dealing with such cases in 5-years retrograde study concerning the diagnostic process and survival rate of patients treated in Oncology Department “Head and Neck surgery” of E.N.T. clinic – University Hospital “Queen Joanna – ISUL” Sofia.

Following a thorough physical examination it is proceeded with head and neck CT and/or MRI, Thoracal X-ray, panendoscopy with a biopsy from suspected primary site. Tosillectomy for diagnostic purposes may be needed. We require a multidisciplinary approach to the problem. Patient treatment requires an ipsilateral neck dissection and adjuvant radiotherapy of the neck area.

Conclusively it becomes apparent that patients, diagnosed with CUP syndrome, have worse survival rates compared to other HNSCC patients. Postoperative radiotherapy lowers the chance of relapse of the disease.

Regardless of the histopathological diagnosis, imbedded in our treatment algorithm, is a postoperative radiotherapy of: oral and pharyngeal mucosa, the neck lymph nodes regions and upper mediastinum region.

Key words: metastases, primary tumor, lymph node, unknown primary site, survival rate, radiotherapy

Publication History

Publication Date:
23 April 2019 (online)