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Occult primary head and neck carcinoma

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Abstract

Unknown primary carcinoma presenting as cervical lymph node metastasis accounts for approximately 5% of all head and neck malignancies. The typical presentation involves a middle-aged man with a painless neck mass that has been present for several months. Over 90% of these malignancies represent squamous cell carcinoma originating within Waldeyer’s ring (lymphoid tissue of the nasopharynx, tonsil, and base of tongue). The remainder are comprised of adenocarcinoma, melanoma, and other rare histologic variants. The ability to identify the occult primary tumor is imperative because identification allows site-specific therapy and avoidance of wide-field radiation side effects. Following confirmation of metastatic cervical disease with fine-needle aspiration, all patients presenting with an unknown primary carcinoma require a thorough head and neck history and physical examination, radiographic imaging, panendoscopy with directed biopsies of Waldeyer’s ring, and bilateral tonsillectomy. Positron emission tomography has proved helpful in identifying occult primary tumors of the head and neck region.

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References and Recommended Reading

  1. Braams JW, Pruim J, Kole AC, et al.: Detection of unknown primary head and neck tumors by positron emission tomography. Int J Oral Maxillofac Surg 1997, 26:112–115.

    Article  PubMed  CAS  Google Scholar 

  2. Miller FR, Hussey D, Beeram M, et al.: Positron emission tomography in the management of unknown primary head and neck carcinoma. Arch Otolaryngol Head Neck Surg 2005, 131:626–629.

    Article  PubMed  Google Scholar 

  3. Chephea D, Koch W, Pitman K: Management of unknown primary tumor. Head Neck 2003, 25:499–504.

    Article  Google Scholar 

  4. Ferris RL, Branstetter BF, Nayak JV: Diagnostic utility of positron emission tomography-computed tomography for predicting malignancy in cystic neck masses in adults. Laryngoscope 2005, 115:1979–1982.

    Article  PubMed  Google Scholar 

  5. Iganej S, Kagan R, Anderson P, et al.: Metastatic squamous cell carcinoma of the neck from an unknown primary: management options and patterns of relapse. Head Neck 2002, 24:236–246.

    Article  PubMed  Google Scholar 

  6. Mendenhall WM, Mancuso AA, Parsons JT, et al.: Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site. Head Neck 1998, 20:739–744.

    Article  PubMed  CAS  Google Scholar 

  7. Ghosh L, Dahut W, Kakar S, et al.: Management of patients with metastatic cancer of unknown primary. Curr Probl Surg 2005, 42:12–66.

    Article  PubMed  Google Scholar 

  8. Wax MK, Myers LL, Gabalski EC, et al.: Positron emission tomography in the evaluation of synchronous lung lesions in patients with untreated head and neck cancer. Arch Otolaryngol Head Neck Surg 2002, 128:703–707.

    PubMed  Google Scholar 

  9. Halpenny W, Hain SF, Biassoni L, et al.: FDG-PET; A possible prognostic factor in head and neck cancer. Br J Cancer 2002, 86:512–516.

    Article  Google Scholar 

  10. Kostakoglu L, Goldsmith SJ: PET in the assessment of therapy response in patients with carcinoma of the head and neck and esophagus. J Nucl Med 2004, 45:56–68.

    PubMed  Google Scholar 

  11. Jungehulsing M, Scheidhauer K, Damm M, et al.: 2 (18F) flouro-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 2002, 123:294–301.

    Article  Google Scholar 

  12. Zimmer LA, Branstetter BF, Nayak JV, Johnson J: Current use of 18-F-Flourodeoxyglucose positron emission tomography and combined positron emission tomography and computed tomography in squamous cell carcinoma of the head and neck. Laryngoscope 2005, 115:2029–2034.

    Article  PubMed  Google Scholar 

  13. Nanni C, Rubello D, Castelluci P, et al.: Role of 18 F-FDG PET-CT imaging for the detection of an unknown primary tumor: preliminary results in 21 patients. Eur J Nucl Med Molecular Imaging 2005, 32:589–592.

    Article  CAS  Google Scholar 

  14. Pavlidis N, Briasoulis E, Hainsworth J, Greco FA: Diagnostic and therapeutic management of an unknown primary. Eur J Cancer 2003, 39:1990–2005.

    Article  PubMed  CAS  Google Scholar 

  15. Miller FR, Karnad A, Eng T, et al.: Management of the unknown primary carcinoma; the long term follow-up on a negative PET scan. Head Neck 2006, in press.

  16. Colletier PJ, Garden AS, Morrison WH, et al.: Postoperative radiation for squamous cell carcinoma metastatic to cervical lymph nodes from an unknown primary site: outcomes and patterns of failure. Head Neck 1998, 20:674–681.

    Article  PubMed  CAS  Google Scholar 

  17. Harper CS, Mendenhall WM, Parsons JT, et al.: Cancer in neck nodes with unknown primary site: role of mucosal radiotherapy. Head Neck 1990, 12:463–469.

    Article  PubMed  CAS  Google Scholar 

  18. Maulard C, Housset M, Brunel P, et al.: Postoperative radiation therapy for occult cervical lymph node metastases from an occult squamous cell carcinoma. Laryngoscope 1992, 102:884–890.

    Article  PubMed  CAS  Google Scholar 

  19. Coster JR, Foote RL, Olsen KD, et al.: Cervical nodal metastases of squamous cell carcinoma of unknown origin: indications for withholding radiation therapy. Int J Radiat Oncol Biol Phys 1992, 23:743–749.

    PubMed  CAS  Google Scholar 

  20. Cooper JS, Pajak TG, Forastiere AA, et al.: Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 2004, 350:1937–1944.

    Article  PubMed  Google Scholar 

  21. Chorost MI, McKinley B, Tschoi M: The management of the unknown primary. J Am Coll Surg 2001, 193:666–677.

    Article  PubMed  CAS  Google Scholar 

  22. Hunt JL, Tomaszewski JE, Montone KT: Prostatic adenocarcinoma metastatic to the head and neck and the workup of an unknown epithelioid neoplasm. Head Neck 2004, 26:171–178.

    Article  PubMed  Google Scholar 

  23. Mason AC, Azari KK, Farkas LM, et al.: Metastatic adenocarcinoma of the colon presenting as a mass in the mandible. Head Neck 2005, 27:729–732.

    Article  PubMed  Google Scholar 

  24. Lentsch EJ, Myers JN: Melanoma of the head and neck: Current concepts in diagnosis and management. Laryngoscope 2001, 111:1209–1222.

    Article  PubMed  CAS  Google Scholar 

  25. Garbe C: Cutaneous melanoma: baseline and ongoing laboratory evaluation. Dermatol Ther 2005, 18:413–421.

    Article  PubMed  Google Scholar 

  26. Wagner JD, Schauwecker D, Davidson D, et al.: Inefficiency of F-18 flourodeoxy-D-glucose-positron emission tomography scans for initial evaluation in early stage cutaneous melanoma. Cancer 2005, 104:570–579.

    Article  PubMed  Google Scholar 

  27. Briggs RD, Pouu AM, Schnadig VJ: Cystic metastases versus branchial cleft carcinoma: a diagnostic challenge. Laryngoscope 2002, 112:1010–1014.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Otolaryngology-Head Neck Surgery, University of Texas Health Science Center San Antonio, Mail Code 7777, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA

    Frank R. Miller MD

Authors
  1. Cecelia E. Schmalbach MD
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  2. Frank R. Miller MD
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Correspondence to Frank R. Miller MD.

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Schmalbach, C.E., Miller, F.R. Occult primary head and neck carcinoma. Curr Oncol Rep 9, 139–146 (2007). https://doi.org/10.1007/s11912-007-0012-5

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