Metastases of an EpidermoidCarcinoma into Cervical Lymph Nodes with an Unknown Primary Tumour

Overview

From 1989 to 1999 seventy patients with the diagnosis of cervical lymph nodemetastases from an unknown primary site were examined and treated at the Department ofOtorinolaryngology in Bratislava. 55 suffered from metastatic epidermoid carcinoma, 14 had a me-tastasis of different carcinoma and on had a metastasis of a malignant melanoma. Diagnosticprocedures include fibroscopy, rigid panendoscopy, excision from the epipharynx, tonsillectomyand “blind” biopsy from suspicious tissue. Fine needle biopsy of the cervical lymph nodes is therecommended initial biopsy technique. Open biopsy has to be reserved after search for a head andneck primary tumour is completed. In patients with no identified primary tumour site, the prognosisdepends on the site and extent of neck involvement. The neck stage before any treatment wasunknown in 5 patients, N1 in 7 patients, N2a in 22 patients, N2b in 3 patients N2c in 5 patients andN3 in 28 patients. Combination of neck dissection and radiotherapy was the most frequent treatment(27 patients). Radiotherapy was limited to the cervical lymphatic system and and was not appliedto all mucosal surfaces in the head and neck region. Chemotherapy was used in N3 cases withpalliative intention. The presumed primary site was detected in 18% cases during or after therapy.The 5-year survival rate was poor - only 9%. In N3 cases mortality was 100% within one year.Diagnostic and therapeutic guidelines for patients with confirmed metastases in cervical lymphnodes from unknown primary tumours are discussed.

Key words:
cancer metastasis, cervical lymph nodes, unknown primary tumour.