Cervical metastasis of undetermined origin: evaluation and criteria for management
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20222686Keywords:
Head and neck, Cervical metastasis, Primary site, Panendoscopy, ChemoradiationAbstract
Background: Cervical metastatic cancer of undetermined primary site is described as the presence of metastasis in the cervical lymph node(s) without any identifiable primary site, despite detailed clinical and investigative evaluations. Identification of primary origin is still a big challenge even in the phase of modern diagnostic options. This review was meant to lay open the challenges and offer options of evaluation and managing these cases in a resource limited environment.
Methods: The literature search was carried out to retrieve relevant published articles, books, guidelines. The search was limited to articles in English while unpublished literatures were excluded.
Results: The process of metastasis might begin before the obvious growth of the primary mass, making detection of primary site of a malignant tumour difficult to determine. There is no current worldwide consensus for evaluation and treatment of cervical metastasis of undetermined primary; however, the primary purpose for management should be towards cure along with locoregional control. This is always based on a well-studied natural history of the mucosal squamous cell cancers of the upper aerodigestive tract.
Conclusions: The first step in the work up remains thorough clinical evaluation and the minimum evaluation should include computed tomography scan of the head and neck, core needle biopsy of the metastatic cervical lymph node(s) for histological analysis, panendoscopy and biopsies from suspicious sites in the upper airway. Treatment modalities can be classified into modified radical neck dissection with or without adjuvant radiotherapy, radiotherapy alone, and combination of surgical intervention and chemoradiation.
Metrics
References
Saltman BE, Yom SS. Head and neck squamous cell carcinoma of unknown primary. UpToDate. 2017.
Furrukh M, Burney I, Qureshi A, Lakhtakia R. Cancer of Unknown Primary Site: Not All is Lost!. J Clin Diagn Res. 2015;3:115.
ESMO. Guideline task force ESMO minimum clinical recommendations for diagnosis, treatment and follow-up of cancers of unknown primary site (CUP). Ann Oncol. 2001;12:1057-8.
Abbruzzese J, Abbruzzese M, Hess K, Raber M, Lenzi R, Frost P. Unknown primary carcinoma: natural history and prognostic factors in 657 consecutive patients. J Clin Oncol. 1994;6:1272-80.
Hainsworth JD, Weiss LM. Carcinoma of an Unknown Primary Site. Cancer Network. 2015;1-8.
Mackenzie K, Watson M, Jankowska P, Bhide S, Simo R. Investigation and management of the unknown primary with metastatic neck disease: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(2):170-5.
Grau C, Johansen L V, Jakobsen J, Geertsen P, Andersen E, Jensen BB. Cervical lymph node metastases from unknown primary tumours. Results from a national survey by the Danish Society for Head and Neck Oncology. Radiother Oncol. 2000;55(2):121‐9.
Briasoulis E, Pavlidis N. Cancer of Unknown Primary Origin. Oncologist. 1997;2:142-52.
Pavlidis N, Plataniotis G. Cervical Lymph Node Metastases of Squamous Cell Carcinoma from an Unknown Primary Site. Coll Antropol. 2012;36(2):27-32.
Calabrese L, Jereczek-Fossa BA, Jassem J, Rocca A, Bruschini R, Orecchia R, et al. Diagnosis and management of neck metastases from an unknown primary. Acta Otorhinolaryngol Ital. 2005;25(1):2-12.
Ofo E, Spiers H, Kim D, Duvvuri U. Transoral Robotic Surgery and the Unknown Primary. ORL. 2018;80:148-55.
Nieder C, Ang K. Cervical lymph node metastases from occult squamous cell carcinoma. Curr Treat Options Oncol. 2002;3:33-40.
Adams JR, O’Brien CJ. Unknown primary squamous cell carcinoma of the head and neck: a review of diagnosis, treatment and outcomes. Asian J Surg. 2002;25(2):188-93.
Guntinas-Lichius O, Klussmann JP, Dinh S, Dinh M, Schmidt M, Semrau R, et al. Diagnostic work-up and outcome of cervical metastases from an unknown primary. Acta Otolaryngol. 2006;126(5):536-44.
Hung Y, Liu S, Wang C, Wang C. Treatment outcomes of unknown primary squamous cell carcinoma of the head and neck. PLoS One. 2018;13(10):e0205365.
Zhuang SM, Wu X-F, Li J-J, Zhang G-H. Management of lymph node metastases from an unknown primary site to the head and neck (Review). Mol Clin Oncol. 2014;2(6):917-22.
Ozer E. Management of Carcinoma of Unknown Primary in the Neck : Changing Dynamics. Austin J Otolaryngol. 2014;1(3):2-3.
Ologe FE, Adeniji K, Segun-Busari S. Clinicopathological study of head and neck cancers in Ilorin, Nigeria. Trop Doct. 2005;35:4-7.
Ayodele SO, Omokanye HK, Segun-Busari S, Ibrahim OOK, Afolabi OA, Folaranmi OO, et al. A review of the clinicopathologic pattern of head and neck malignant tumours in Ilorin, Nigeria. Highl Med Res J. 2020;20(1):40-4.
Stella GM, Senetta R, Cassenti A, Ronco M, Cassoni P. Cancers of unknown primary origin: Current perspectives and future therapeutic strategies. J Transl Med. 2012;10:12.
Lopez F, Rodrigo JP, Silver CE, Haigentz Jr M, Bishop JA, Strojan P, et al. Cervical lymph node metastases from remote primary tumor sites. Head Neck. 2016;38(3):E2374-85.
Sudoko CK, Polacco MA, Gosselin BJ, Paydarfar JA. Diagnostic Value of lingual Tonsillectomy in Unknown Primary head and neck carcinoma identification after a negative clinical Workup and Positron emission Tomography-computed Tomography. Front Oncol. 2018;8:118.
Kulapaditharom B, Boonkitticharoen, V Kunachak S. Fluorescence-guided biopsy in the diagnosis of an unknown primary cancer in patients with metastatic cervical lymph nodes. Ann Otol Rhinol Laryngol. 1999;108(7 Pt 1):700-4.
Saskatchewan Cancer Agency. Unknown Primary of Head and Neck Cancer Treatment Guidelines Provincial Unknown Primary of Head and Neck Cancer Treatment Guidelines. Canada. 2015.
Civantos FJ, Vermorken JB, Shah JP, Rinaldo A, Suárez C, Kowalski LP, et al. Metastatic Squamous Cell Carcinoma to the Cervical Lymph Nodes From an Unknown Primary Cancer: Management in the HPV Era. Front Oncol. 2020;10:593164.
Mustafa Z, Baloch FA, Khalid A. Diagnostic value of fine needle aspiration cytology in metastatic lymphadenopathy. Int J Pathol. 2015;13(1):7-13.
Allin D, David S, Jacob A, Mir N, Giles A, Gibbins N. Use of core biopsy in diagnosing cervical lymphadenopathy: a viable alternative to surgical excisional biopsy of lymph nodes? Ann R Coll Surg Engl. 2017;99:242-4.
Burke C, Thomas R, Inglis C, Baldwin A, Ramesar K, Grace R, et al. Ultrasound-guided core biopsy in the diagnosis of lymphoma of the head and neck. A 9 year experience. Br J Radiol. 2011;84:727-32.
Ryu Y, Cha W, Jeong W, Choi S, Ahn S. Diagnostic role of core needle biopsy in cervical lymphadenopathy. Head Neck. 2015;37(2):229-33.
Monfore N, Jarmakani M, Wagner JM. The Role of Core-Needle Biopsy in the Evaluation of Head and Neck Lesions. J Am Osteopat Coll Radiol. 2018;7(2):10-21.
Grün JM, Tahtali A, Ghanaati S, Rödel C, Balermpas P. Diagnostic and treatment modalities for patients with cervical lymph node metastases of unknown primary site – current status and challenges. Radiat Oncol. 2017;12:82.
Boellaard R, O’Doherty MJ, Weber WA, Mottaghy FM, Lonsdale MN, Stroobants SG, et al. FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging. Eur J Nucl Med Mol Imaging. 2010;37(1):181-200.
Pereira G, Silva JC, Monteiro E. Positron emission tomography in the detection of occult primary head and neck carcinoma: A retrospective study. Head Neck Oncol. 2012;4:34.
Kwee TC, Kwee RM. Combined FDG-PET/CT for the detection of unknown primary tumors: Systematic review and meta-analysis. Eur Radiol. 2009;19(3):731-44.
Pepper C, Pai I, Hay A, Deery A, Wilson P, Williamson P, et al. Investigation strategy in the management of metastatic adenocarcinoma of unknown primary presenting as cervical lymphadenopathy. Acta Otolaryngol. 2014;134:838‑42.
Krishnamurthy A. Metastatic adenocarcinoma of unknown primary presenting with cervical lymphadenopathy: A diagnostic challenge. J Can Res Ther. 2017;13:599-601.
Cutler CS, Bailey E, Kumar V, Schwarz SW, Bom H, Hatazawa J, et al. Global Issues of Radiopharmaceutical Access and Availability: A Nuclear Medicine Global Initiative Project. J Nucl Med. 2021;62:622-30.
Wang Y, He S, Bao Y, Cai X, Chen H, Yang X, et al. Cervical lymph node carcinoma metastasis from unknown primary site: a retrospective analysis of 154 patients. Cancer Med. 2018;7(5):1852-9.
Cerezo L, Raboso E, Ballesteros AI. Unknown primary cancer of the head and neck: A multidisciplinary approach. Clin Transl Oncol. 2011;13(2):88-97.
Pinkiewicz M, Dorobisz K, Zatoński T. A systematic review of cancer of unknown primary in the head and neck region. Cancer Manag Res. 2021;13:7235-41.
Rodríguez L, Otero W, Grosso F. A review of metastatic cancer with unknown primary cancer. Rev Colomb Gastroenterol. 2018;33(2):133-42.
Boscolo-Rizzo P, Da Mosto MC, Gava A, Marchiori C. Cervical lymph node metastases from occult squamous cell carcinoma: Analysis of 82 cases. ORL. 2006;68:189-94.
Davidson BJ, Spiro RH, Patel S, Patel K, Shah JP. Cervical metastases of occult origin: The impact of combined modality therapy. Am J Surg. 1994;168(5):395-9.
Abu-Shama Y, Salleron J, Carsuzaa F, Sun XS, Pflumio C, Troussier I, et al. Impact of neck dissection in head and neck squamous cell carcinomas of unknown primary. Cancers (Basel). 2021;13:2416.
Downloads
Published
How to Cite
Issue
Section
