Metastatic neck nodes of unknown primary origin

The patient who presents with a metastatic node in the neck should first have a thorough examination of the upper part of the respiratory tract and then a needle aspiration biopsy of the neck mass to confirm the diagnosis of cancer. Biopsy excision or incision of the neck tumour is unnecessary and can prejudice the patient's survival. In approximately 85% of cases, the occult primary tumour will be discovered after endoscopic examination with biopsies of appropriate areas. At the Prince of Wales Hospital, 43 patients received treatment for metastatic neck lesions where no primary tumour was found before definitive treatment. These patients were divided into three groups. Seventeen patients had potentially curable neck tumours, while the remaining two groups were divided into those with incurable neck masses and those with supraclavicular nodes. The three-year survival rate for the potentially curable group was 64%. However, only one patient in the other two groups survived. Radiotherapy to the neck node and likely primary site is recommended as the main form of therapy for nodes up to 3 cm in diameter. For nodes greater than 3 cm, a combination of surgery and radiotherapy gives the best results.