Occult primary of the head and neck

This paper reviews clinical presentation, diagnosis, and treatment of 199 cases of metastatic carcinoma of the neck with an occult primary, seen at the Cancer Control Agency of British Columbia from 1950-1975. In 35 patients a primary tumor was ultimately found, with the commonest location the nasopharynx. In a further 46 patients a primary was suspected on a clinical basis only. The other 118 cases remained occult. Therapeutic results of the whole series and individual groups are analyzed. Best survival was found in those in whom a primary source was ultimately demonstrated. Single, small, mobile cervical nodes had the best prognosis. Supraclavicular nodes indicated a poor prognosis and an even greater need to search for an infraclavicular primary. A comparative review of the literature is included.