Unknown/Occult Primary Cancers (CUP) of Head & Neck: Treatment strategies for cervical metastases (SCC)

Resectable (N1/N2a,b,c)
- Comprehensive neck dissection (MND/RND)
  - Multiple nodal metastases: Postoperative radiotherapy (RT)
  - Extranodal extension (ENE): Postoperative chemoradiotherapy (CRT) or radiotherapy (RT)
- Primary RT or CRT with salvage neck dissection for persistent nodes / recurrence
Unresectable
- (C)RT
- Salvage neck dissection for persistent nodes or recurrence
Contralateral N0 neck
- Controversial; no standardised approach
- Consider patient’s performance status
- Consider treating contralateral neck if
  - CUP node mass >3cm
  - Multiple ipsilateral involved nodes
  - Tonsillectomy does not yield cancer and HPV features (level 2, cystic, basaloid), then assume likely to be a base of tongue primary