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Squamous cell carcinoma of unknown head and neck primary site 

Squamous cell carcinoma of unknown head and neck primary site
Chapter:
Squamous cell carcinoma of unknown head and neck primary site
Author(s):

Suat W. Loo

and Tom Roques

DOI:
10.1093/med/9780199664535.003.0001
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date: 20 August 2019

Approximately 3% of patients with head and neck squamous cell carcinoma present as cervical lymph node metastasis from an unknown primary site. Initial evaluation of these patients should include a detailed history and a complete physical examination, flexible nasoendoscopy, imaging studies and needle biopsy of the cervical lymph node. Fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography (18FDG PET-CT) permits detection of occult primary tumours in up to 40% of cases. The primary cancer is more likely to be located within the oropharynx if immunohistochemical analysis of tumour cells showed strong p16 expression. In addition, an evaluation under general anaesthesia also allows the detection of primary tumours too small to be visualised on FDG PET-CT in up to 15% of cases. The optimal management of patients presenting with squamous cell carcinoma from an unknown head and neck primary site remains undefined and treatment depends largely on the nodal stage at presentation.

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