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Head and neck squamous cell carcinoma of unknown primary
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of head and neck squamous cell carcinoma of unknown primary are prepared by our editorial team based on guidelines from the American Society of Clinical Oncology (ASCO 2020).
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Diagnostic investigations
Initial evaluation: as per ASCO 2020 guidelines, obtain a thorough history and physical examination in patients undergoing evaluation for a neck mass suspicious for SCC, including fiberoptic laryngoscopy, optionally with advanced visualization techniques, such as narrow-band imaging, to facilitate identification of the anatomic location of the primary tumor and to inform potential therapeutic management options.
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Diagnostic imaging
Viral testing
Diagnostic procedures
Fine-needle aspiration and biopsy: as per ASCO 2020 guidelines, perform fine-needle aspiration or core biopsy for a clinically suspicious neck mass.
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Surgical evaluation
Medical management
Systemic therapy: as per ASCO 2020 guidelines, offer concurrent administration of cisplatin with definitive radiotherapy in patients without contraindications to cisplatin chemotherapy and with a suspected mucosal primary HPV/p16-negative SCC in the presence of unresected N2-N3 nodal disease.
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Therapeutic procedures
Primary radiotherapy: as per ASCO 2020 guidelines, administer primary radiotherapy or concurrent chemoradiotherapy in patients with carcinoma of unknown primary, targeting gross nodal disease, neck regions at risk for microscopic disease, and anatomic mucosal regions at risk for harboring the occult primary. Tailor specific treatment volumes based on the clinicopathologic presentation after a complete workup.
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Adjuvant radiotherapy