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
