CERVICAL LYMPH NODE METASTASES FROM CARCINOMA OF UNDETERMINED ORIGIN

Our experience at the I. González Martínez Hospital with 80 cases of metastatic carcinoma to cervical lymph nodes from an undetermined primary tumor has been reviewed.

The majority of cases was found above the age of 50 years and the male to female ratio was approximately 2 to 1.

In 63 of the 80 cases studied, the metastatic manifestation constituted a large tumor mass, and due to this fact, lymph node incision or needle biopsy was performed for diagnostic purposes in most of the cases.

Epidermoid carcinoma and anaplastic carcinoma were the most frequent pathologic diagnoses, 52 and 34 per cent, respectively.

Radiotherapy was the treatment of choice in 52 per cent of the cases; most of the cases who underwent radiotherapy as primary treatment had advanced metastatic disease or were not considered candidates for radical surgery. Surgery was the main treatment modality in 23 of the cases (29 per cent), but 16 of them received additional postoperative radiotherapy. Fourteen cases received no treatment. The 5 year survival for the 38 treated cases traced was 21 per cent. The 8 cases who survived 5 years or more had their metastatic lymph nodes in the upper and mid parts of the neck.

The primary lesion was discovered in 8 of our 80 cases and these are analyzed separately.

In our opinion, early detection of an enlarged lymph node in the neck, careful search for the origin of the primary lesion, and the close collaboration between surgeons and radiotherapists in the evaluation and management of patients with metastatic disease from undetermined origin will lead to the best results. A meticulous follow-up in these patients is considered of utmost importance to discover the primary lesion at an early stage of tumor growth when effective curative treatment can be established.

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