Lymph Node Metastases in the Neck from Unknown Primary Sites

Abstract

Objective: To evaluate the experience of the Kuwait Cancer Control Center in the diagnosis and management of patients with cervical lymph node metastasis from an unknown primary site. Methods: We have undertaken a retrospective study of 24 patients for the years 1979–1994. All cases were pathologically confirmed; a primary tumor was not detected in any of these cases despite extensive diagnostic procedures. There were 24 patients, 9 Kuwaitis and 15 non-Kuwaitis, 20 males and 4 females (5:1). Their ages ranged from 10 to 83 years with a median of 55.5 years. Results: Twenty patients presented with a neck mass. The supraclavicular lymph node was the site in 9 cases; 9 had multinodal metastases, 3 in the upper third of the neck, 2 at the submental-submaxillary level and 1 in the middle third. The local stage of nodal involvement was 6 N₁, 8 N₂ and 9 N₃. The pathological diagnosis was squamous cell carcinoma in 14 cases, adenocarcinoma in 6 cases, 1 undifferentiated case and unknown in 2 cases. Sixteen cases were graded as poorly differentiated. Radiotherapy was used for 9 patients, 4 were treated with chemotherapy, 2 were treated with surgery, 2 were treated with surgery followed by radiotherapy and 2 with chemotherapy and radiotherapy. The median survival was 6 months for the whole group. Conclusion: We concluded that, in patients with metastatic carcinoma to the cervical lymph nodes from an unknown primary, supraclavicular localization and male gender were high risk factors. The prognosis in these cases was disastrous because of late diagnosis, and therapy was only palliative.