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Review

Management of lymph node metastases from an unknown primary site to the head and neck (Review)

  • Authors:
    • Shi Min Zhuang
    • Xi‑Fu Wu
    • Jing‑Jia Li
    • Ge‑Hua Zhang
  • View Affiliations / Copyright

    Affiliations: Department of Otorhinolaryngology-Head and Neck Surgery, The Third Affiliated Hospital of Sun Yat‑sen University, Guangzhou, Guangdong 510630, P.R. China
  • Pages: 917-922
    |
    Published online on: July 29, 2014
       https://doi.org/10.3892/mco.2014.361
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Abstract

Cancer of unknown primary site (CUP) is an intriguing clinical phenomenon found in ~3‑9% of all head and neck cancers. It has not yet been determined whether CUP forms a distinct biological entity with specific genetic and phenotypic characteristics, or whether it is the clinical presentation of metastasis in patients with an undetected primary tumor and no visible clinical signs. The treatment of patients with cervical lymph node metastases from CUP remains controversial, due to the lack of randomized clinical trials comparing different treatment options. Consequently, treatment is currently based on non‑randomized data and institutional policy. In the present review, the range and limitations of diagnostic procedures are summarized and an optimal diagnostic work‑up is recommended. The initial preferred diagnostic procedures include fine‑needle aspiration biopsy (FNAB) and imaging. Although neck dissection followed by postoperative radiotherapy is the the most generally accepted approach, other curative options may be used in certain patients, such as neck dissection alone, nodal excision followed by postoperative radiotherapy, or radiotherapy alone. There remains controversy regarding target radiation volumes, ranging from ipsilateral neck irradiation to prophylactic irradiation of all the potential mucosal sites and both sides of the neck. When no primary lesion is identified with imaging and endoscopy in patients without history of smoking and alcohol abuse, molecular profiling of an FNAB sample for human papillomavirus and/or Epstein‑Barr virus is required.
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Copy and paste a formatted citation
Spandidos Publications style
Zhuang SM, Wu XF, Li JJ and Zhang GH: Management of lymph node metastases from an unknown primary site to the head and neck (Review). Mol Clin Oncol 2: 917-922, 2014.
APA
Zhuang, S.M., Wu, X., Li, J., & Zhang, G. (2014). Management of lymph node metastases from an unknown primary site to the head and neck (Review). Molecular and Clinical Oncology, 2, 917-922. https://doi.org/10.3892/mco.2014.361
MLA
Zhuang, S. M., Wu, X., Li, J., Zhang, G."Management of lymph node metastases from an unknown primary site to the head and neck (Review)". Molecular and Clinical Oncology 2.6 (2014): 917-922.
Chicago
Zhuang, S. M., Wu, X., Li, J., Zhang, G."Management of lymph node metastases from an unknown primary site to the head and neck (Review)". Molecular and Clinical Oncology 2, no. 6 (2014): 917-922. https://doi.org/10.3892/mco.2014.361
Copy and paste a formatted citation
x
Spandidos Publications style
Zhuang SM, Wu XF, Li JJ and Zhang GH: Management of lymph node metastases from an unknown primary site to the head and neck (Review). Mol Clin Oncol 2: 917-922, 2014.
APA
Zhuang, S.M., Wu, X., Li, J., & Zhang, G. (2014). Management of lymph node metastases from an unknown primary site to the head and neck (Review). Molecular and Clinical Oncology, 2, 917-922. https://doi.org/10.3892/mco.2014.361
MLA
Zhuang, S. M., Wu, X., Li, J., Zhang, G."Management of lymph node metastases from an unknown primary site to the head and neck (Review)". Molecular and Clinical Oncology 2.6 (2014): 917-922.
Chicago
Zhuang, S. M., Wu, X., Li, J., Zhang, G."Management of lymph node metastases from an unknown primary site to the head and neck (Review)". Molecular and Clinical Oncology 2, no. 6 (2014): 917-922. https://doi.org/10.3892/mco.2014.361
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