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

Index: Clinical Practice Guidelines for CUP

Resource Appropriate CUP Guideline Scenarios