Cancer Institute A national cancer institute
designated cancer center

Neck Cancer Expertise

(Carcinoma in neck without an indentified primary; primary tumors arising in neck)

Occasionally there is a cancer that presents in the neck without a prior history of skin cancer or cancer elsewhere and without signs or suggesting from whence it arose. When this happens a complete head and neck physical exam may reveal the origin, but not always. When it does not, a fine needle aspirate biopsy (FNA) is usually sufficient to establish the nature of the neck mass. Imaging studies that usually include a PET-CT and an MRI would be done to try to locate the origin. If still not helpful, selected biopsies of sites where small subtle tumors might arise would be done. If for example the FNA shows an HPV (+) tumor (see oropharynx) biopsies of the tonsil and the base of tongue, possibly with TORS, would be done as well as inspecting via fiberoptic scopes the esophagus, trachea, and lungs. If the origin of the tumor is not found then treatment would be based on a number of factors, and might include surgery alone, chemoradiation alone, or a combination.

Sometimes a prior malignancy controlled by prior intervention manifests as new spread to a lymph node in the neck. A FNA usually establishes the diagnosis. Management depends on the extent of involvement in the neck and elsewhere, and whether there has been prior neck irradiation. These can be complex decisions and the options will be discussed at the weekly multispecialty patient care conferences.

There are a number of rare benign and malignant tumors that can originate in structures in the neck. These include sarcomas and rare conditions that involve nerves or lymph nodes. Treatment is tailored to the nature of the problem, the extent of involvement, and other medical and personal factors.

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