ABSTRACT
Occult primary cancer is an intriguing clinical phenomenon that develops in 3–9% of all head and neck cancers. Neck node metastasis appears in around 5–10% of all patients with occult primary. Metastasis in upper and middle neck occurs from head and neck cancers; on the other hand, metastasis to lower neck is associated with cancers that arise from below the clavicles such as thyroid, lung, and gastrointestinal cancers. A diagnostic setup consists of clinical evaluation such as panendoscopy of upper aerodigestive tract, computed tomography (CT), and MRI; biopsies such as fine-needle aspiration cytology (FNAC) and open biopsy; and molecular assay from all suspicious sites. To date, the therapeutic management of a patient with occult primary remains controversial due to the absence of randomized control studies comparing different treatment options. However, established guidelines for the management of occult primary have been provided by NCCN. Several authors have recommended the surgical removal of neck tumors, followed by postoperative radiotherapy alone or radio-chemotherapy.
