Cervical lymph node metastasis from unknown primary sites

Abstract

Between 1975 and 2002, we treated 12 cases of previously untreated metastatic carcinoma of the cervical lymph nodes from unknown primary sites. The histopathological diagnoses of the cervical masses were as follows: nine cases had squamous cell carcinoma, two had adenocarcinoma, and one had undifferentiated carcinoma. Treatment generally involved radical neck dissection followed by intensive radiation therapy extending from the base of the skull to the clavicle and medially to the midline. Primary lesions became evident in three patients after the initial therapy was concluded. The primary lesions were located in the kidney, lung and oropharynx; these patients died from uncontrolled distant metastasis. Initial radical therapy was performed in eight patients who had no distant metastasis and were in good general condition; eight of these patients have survived for more than three years. Thus, the overall prognosis was not very good. In the present series, surgical treatment by radical neck dissection was performed when possible, and intensive radiation therapy appeared to be effective. This report was based on our experience in the management of cervical nodal metastasis and the survival characteristics of these patients.