Metastatic Squamous Neck Cancer with Occult Primary Treatment (PDQ®): Treatment - Patient Information [NCI]

General Information About Metastatic Squamous Neck Cancer with Occult Primary

Metastatic squamous neck cancer with occult primary is a disease in which squamous cell cancer spreads to lymph nodes in the neck and it is not known where the cancer first formed in the body.

Squamous cells are thin, flat cells found in tissues that form the surface of the skin and the lining of body cavities such as the mouth, hollow organs such as the uterus and blood vessels, and the lining of the respiratory (breathing) and digestive tracts. Some organs with squamous cells are the esophagus, lungs, kidneys, and uterus. Cancer can begin in squamous cells anywhere in the body and metastasize (spread) through the blood or lymph system to other parts of the body.

When squamous cell cancer spreads to lymph nodes in the neck or around the collarbone, it is called metastatic squamous neck cancer. The doctor will try to find the primary tumor (the cancer that first formed in the body), because treatment for metastatic cancer is the same as treatment for the primary tumor. For example, when lung cancer spreads to the neck, the cancer cells in the neck are lung cancer cells and they are treated the same as the cancer in the lung. Sometimes doctors cannot find where in the body the cancer first began to grow. When tests cannot find a primary tumor, it is called an occult (hidden) primary tumor. In many cases, the primary tumor is never found.

Signs and symptoms of metastatic squamous neck cancer with occult primary include a lump or pain in the neck or throat.

Check with your doctor if you have a lump or pain in your neck or throat that doesn't go away. These and other signs and symptoms may be caused by metastatic squamous neck cancer with occult primary. Other conditions may cause the same signs and symptoms.

Tests that examine the tissues of the neck, respiratory tract, and upper part of the digestive tract are used to detect (find) and diagnose metastatic squamous neck cancer and the primary tumor.

Tests will include checking for a primary tumor in the organs and tissues of the respiratory tract (part of the trachea), the upper part of the digestive tract (including the lips, mouth, tongue, nose, throat, vocal cords, and part of the esophagus), and the genitourinary system. In addition to asking about your personal and family health history and doing a physical exam, your doctor may perform the following tests and procedures:

• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist or tested in the laboratory to check for signs of cancer.

  Three types of biopsy may be done:

  • Fine-needle aspiration (FNA) biopsy: The removal of tissue or fluid using a thin needle.
  • Core needle biopsy: The removal of tissue using a wide needle.
  • Excisional biopsy: The removal of an entire lump of tissue.

  The following procedures are used to remove samples of cells or tissue:

  • Tonsillectomy: Surgery to remove both tonsils.
  • Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through an incision (cut) in the skin or opening in the body, such as the mouth or nose. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove abnormal tissue or lymph node samples, which are checked under a microscope for signs of disease. The nose, throat, back of the tongue, esophagus, stomach, voice box, windpipe, and large airways will be checked.

  One or more of the following laboratory tests may be done to study the tissue samples:

  • Immunohistochemistry: A laboratory test that uses antibodies to check for certain antigens (markers) in a sample of a patient's blood or bone marrow. The antibodies are usually linked to an enzyme or a fluorescent dye. After the antibodies bind to a specific antigen in the blood or bone marrow, the enzyme or dye is activated, and the antigen can then be seen under a microscope. This type of test is used to help diagnose cancer and to help tell one type of cancer from another type of cancer.
  • Light and electron microscopy: A test in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.
  • Epstein-Barr virus (EBV) and human papillomavirus (HPV) test: A test that checks the cells in a sample of tissue for EBV and HPV DNA.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  
  Computed tomography (CT) scan of the head and neck. The patient lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the head and neck.
• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. A whole body PET scan and a CT scan are done at the same time to look for where the cancer first formed. If there is any cancer, this increases the chance that it will be found.

A diagnosis of occult primary tumor is made if the primary tumor is not found during testing or treatment.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis and treatment options depend on the following:

• The number and size of lymph nodes that have cancer in them.
• Whether the cancer has responded to treatment or has recurred (come back).
• How different from normal the cancer cells look under a microscope.
• The patient's age and general health.

Treatment options also depend on the following:

• Which part of the neck the cancer is in.
• Whether certain tumor markers are found.

Stages of Metastatic Squamous Neck Cancer with Occult Primary

After metastatic squamous neck cancer with occult primary has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body.

The process used to find out if cancer has spread to other parts of the body is called staging. There is no standard staging system for metastatic squamous neck cancer with occult primary. Depending on whether the cancer was caused by human papillomavirus 16 or Epstein-Barr virus, oropharyngeal or nasopharyngeal cancer staging may be used. For more information, see the section called Stage Information for Metastatic Squamous Neck Cancer with Occult Primary in the health professional version of this page.

The results from tests and procedures used to detect and diagnose the primary tumor are also used to find out if cancer has spread to other parts of the body.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Metastatic squamous neck cancer with occult primary can recur (come back) after it has been treated.

The cancer may come back in the neck or in other parts of the body.

Treatment Option Overview

There are different types of treatment for patients with metastatic squamous neck cancer with occult primary.

Different types of treatment are available for patients with metastatic squamous neck cancer with occult primary. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

The following types of treatment are used:

Surgery

Surgery may include neck dissection. There are different types of neck dissection, based on the amount of tissue that is removed.

• Radical neck dissection: Surgery to remove tissues in one or both sides of the neck between the jawbone and the collarbone, including the following:
  • All lymph nodes.
  • The jugular vein.
  • Muscles and nerves that are used for face, neck, and shoulder movement, speech, and swallowing.
  The patient may need physical therapy of the throat, neck, shoulder, and/or arm after radical neck dissection. Radical neck dissection may be used when cancer has spread widely in the neck.
• Modified radical neck dissection: Surgery to remove all the lymph nodes in one or both sides of the neck without removing the neck muscles. The nerves and/or the jugular vein may be removed.
• Partial neck dissection: Surgery to remove some of the lymph nodes in the neck. This is also called selective neck dissection.

After the doctor removes all the cancer that can be seen at the time of surgery, some patients may be given radiation therapy after surgery to kill any cancer cells that are left. Treatment given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. Intensity-modulated radiation therapy (IMRT) is a type of 3-dimensional (3-D) external radiation therapy that uses a computer to make pictures of the size and shape of the tumor. Thin beams of radiation of different intensities (strengths) are aimed at the tumor from many angles. This type of radiation therapy is less likely to cause dry mouth, trouble swallowing, and damage to the skin.

External-beam radiation therapy of the head and neck. A machine is used to aim high-energy radiation at the cancer. The machine can rotate around the patient, delivering radiation from many different angles to provide highly conformal treatment. A mesh mask helps keep the patient's head and neck from moving during treatment. Small ink marks are put on the mask. The ink marks are used to line up the radiation machine in the same position before each treatment.

Radiation therapy to the neck may change the way the thyroid gland works. Blood tests may be done to check the thyroid hormone level in the body before treatment and at regular checkups after treatment.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy).

Hyperfractionated radiation therapy

Hyperfractionated radiation therapy is a type of external radiation treatment in which a smaller than usual total daily dose of radiation is divided into two doses and the treatments are given twice a day. Hyperfractionated radiation therapy is given over the same period of time (days or weeks) as standard radiation therapy.

Treatment for metastatic squamous neck cancer with occult primary may cause side effects.

For information about side effects caused by treatment for cancer, visit our Side Effects page.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI's clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Follow-up tests may be needed.

As you go through treatment, you will have follow-up tests or check-ups. Some tests that were done to diagnose or stage the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back).

Treatment of Untreated Metastatic Squamous Neck Cancer with Occult Primary

Untreated metastatic squamous neck cancer with occult primary means that a patient is newly diagnosed and has not been treated, except to relieve signs and symptoms caused by the cancer. For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of untreated metastatic squamous neck cancer with occult primary may include the following:

• Radiation therapy.
• Surgery.
• Radiation therapy followed by surgery.
• A clinical trial of chemotherapy followed by radiation therapy.
• A clinical trial of chemotherapy given at the same time as hyperfractionated radiation therapy.
• Clinical trials of new treatments.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Treatment of Recurrent Metastatic Squamous Neck Cancer with Occult Primary

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of metastatic squamous neck cancer with occult primary that recurs (comes back) after treatment is usually within a clinical trial.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

To Learn More About Metastatic Squamous Neck Cancer with Occult Primary

For more information from the National Cancer Institute about metastatic squamous neck cancer with occult primary, see the following:

• Carcinoma of Unknown Primary Home Page
• Head and Neck Cancer Home Page
• Oral Complications of Cancer Therapies
• Metastatic Cancer

For general cancer information and other resources from the National Cancer Institute, visit:

• About Cancer
• Staging
• Chemotherapy and You: Support for People With Cancer
• Radiation Therapy and You: Support for People With Cancer
• Coping with Cancer
• Questions to Ask Your Doctor about Cancer
• For Survivors and Caregivers

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PDQ® Adult Treatment Editorial Board. PDQ Metastatic Squamous Neck Cancer with Occult Primary Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/head-and-neck/patient/adult/metastatic-squamous-neck-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389176]

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Last Revised: 2023-09-21

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