Metastases in the Absence of a Primary Tumor – Advances in the Diagnosis and Treatment of CUP Syndrome: Additional Points From the Perspective of Ear, Nose, and Throat Medicine

The review article shows the problem of CUP (carcinoma unknown primary) syndrome from the perspective of internistic oncology. From the perspective of otolaryngology, head and neck surgery, a few additional points deserve mention. The readers are not provided with information that is crucial for the appropriate diagnosis and treatment of cervical CUP syndrome.

In 70–80% of such cases, the primary tumors are located in the mucosa of the upper aerodigestive tract and take the shape of squamous cell carcinomas (3). In up to 10% of the cervical lymph node metastases, the primary tumors are initially unknown. In imaging studies of CUP, primary tumors of the oropharynx and nasopharynx are described in second place, after lung cancer.

The necessary diagnostic measures described as necessary in the literature were reflected only incompletely. Further to panendoscopy and bilateral tonsillectomy, "blind" biopsies should be taken from the base of the tongue and the nasopharynx. In total, the detection rate of primary tumors then can reach 30% (1, 2).

For the treatment of CUP, the literature clearly points out the benefit of modified radical neck dissection of the side of the neck that is affected and subsequent radiotherapy or radiochemotherapy. The radiation area should reach from the nasopharynx to the upper mediastinum and include both sides of the neck if required. By using this technique, 5 year survival rates in prospective studies have been improved from less than 20% to as high as 50% (2, 3).

In looking at all the available facts we think it is important to point out that oncological diagnosis and treatment are by necessity always influenced by the respective specialist groups and cannot be determined by generalists alone. Only in this way can a complete overview of the current state of diagnostics and therapy be achieved. This forms the basis for the development of unified standards for the benefit of our patients.
DOI: 10.3238/arztebl.2009.0293b


Prof. Dr. med. Hans-Wilhelm Pau
Deutsche Gesellschaft für HNO-Heilkunde, Kopf- u. Hals-Chirugie e. V.
Hittorfstr. 7
53129 Bonn, Germany
info@hno.org

Prof. Dr. med. Heinrich Iro
Arbeitsgemeinschaft Onkologie der Deutschen Gesellschaft für HNO-Heilkunde,
Kopf- u. Hals-Chirurgie e.V., Hittorfstr. 7
53129 Bonn, Germany
info@hno.org