Metastatic cervical lymph nodes with occult primary carcinomas

Metastatic carcinoma in cervical lymph nodes is relatively common in patients with head and neck cancer. Usually, a careful search will reveal the primary tumor in the skin or mucosal surfaces of the head and neck or, rarely, in an area below the clavicles, such as the lungs. In approximately 3% to 11% of cases, however, the primary tumor remains elusive. Controversy exists about which treatment regimens give the best results in patients in whom the primary cancer is not found. This review discusses current concepts in diagnosis, therapeutic options, and prognostic factors. Emphasis is given to recent advances in diagnosis, treatment (including radiation and chemotherapy), and prognosis.