Treatment If a head or neck primary is found with these studies, treatment is given as outlined. If the primary is not found, the treatment is a surgical neck dissection followed by radiation therapy .
• If the lymph nodes in the neck are enlarged or are on both sides, radiation therapy is given first. If any lymph
nodes persist after radiotherapy , then surgical lymph node dissection is done.
• Alternatively, many centers use radiotherapy as the first treatment for unknown primary cancer of the head
and neck. External radiation may be about equally effective as neck dissection for control of neck metastases,
although surgical neck dissection may be required for those tumors that persist or recur after radiotherapy.
• Radiation fields to treat the likely primary sources are extensive and include the nasopharynx , the base of the
tongue and the pyriform sinuses.
• Chemotherapy may also be appropriate for the most treatable likely primary site. Follow-up is extremely
important.
• Options under clinical evaluation include neoadjuvant chemotherapy (cisplatin + 5-fluorouracil) followed by
radiation therapy. Other investigational protocols are available.
Recurrent Cancer If the disease progresses, recurs or relapses, the prognosis is poor. Further treatment depends on the type of cancer, earlier treatment, site of recurrence and personal factors. Patients are candidates for investigational protocols.
