A study of malignant cervical lymphadenopathy with unknown primary

INTRODUCTION: Head and neck cancers account for 2.8% of all newly discovered cancers1. Metastatic carcinoma within cervical lymph nodes with an unknown primary tumour site accounts for 3% to 5% of all head and neck cancers. The control of such regional metastatic disease constitutes a significant part of the process of treating head and neck cancer. The presence of an enlarged node proven histologically positive for metastasis is an ominous findings and as a general rule decreases the 5-year survival rate by at least 50%.When nodal involvement becomes multiple extends low in neck, no patient gets cured regardless of the treatment given. When the primary site of carcinoma is known, focused therapy to the primary site and cervical lymphadenopathy can be given. Without this knowledge clinicians are obligated to treat the entire pharyngeal axis and larynx to cover the possible origins of the metastatic carcinoma. The occult primary treatment regimen results in a significant increase in morbidity to the patient. Proper understanding of the anatomy and detection of cervical metastatic disease is crucial to this process. AIMS OF THE STUDY: 1. To find age and sex incidence of the malignant cervical lymphadenopathy with an unknown primary. 2. To analyse the histopathological types common in our population. 3. To stage the disease at the time of presentation 4. To interpret the possible site of primary based on the nodal involvement. 5. To describe the various investigations used to identify the primary site. 6. To discuss the ideal treatment modality for the patients. MATERIALS AND METHODS: During a period of 29 months from august 2004 to february 2006 datas were collected from 156 patients who were admitted to the surgical units of coimbatore medical college hospital with a diagnosis of cervical lymphadenopathy. Children below 12 years of age were not included. All patients with known primaries were excluded from the study. Likewise patients with lymphatic malignancies were excluded. Patients with infective pathology and non specific lymphadenitis were also excluded from the study. A total of 85 patients were finally included in the study. CONCLUSION: The unknown primary tumour presents several clinical dilemmas including how to find the primary site and, if the site is never found, to direct treatment. The incidence of patients with an unknown primary site is low overall because of the effectiveness of clinical examination coupled with pan endoscopy and directed biopsies. Radiograghic technology including CT/MRI, PET scan, and more recently,PET-CT may be of value in some cases. As these diagnostic methods become more refined there may eventually be no patients with an unknown primary tumour. Of course, once the primary site is identified, treatment of this patients can become much more specifically directed. We hope that in future the unknown primary site will no longer be a featured entry