This aggressive approach, although associated with significant morbidity, has been advocated by many oncologic centers and has also been challenged by others. Metastasis in the upper and middle neck (levels I, II, III and V) are generally attributed to head and neck cancers, whereas level IV is often associated with primaries below the clavicle.Įxtended field radiotherapy can be used to treat the potential primary site of origin in a case of head and neck. Patients who have a metastatic neck lymph node will have their primary tumors discovered in more than 90% of the cases through a careful physical examination, computed tomography (CT) and/or magnetic resonance imaging, endoscopy and biopsies and, more recently, by elective tonsillectomies and newer imaging techniques such as positron emission tomography scans. The 5-year disease-specific survival rates range upwards to 74% in modern series, with overall survival rates being in the 40–66% range. Metastasis of unknown primary on the whole carries a very poor prognosis, but in the head and neck region this is not the case. Metastasis to the lymph nodes of the neck with an occult primary is relatively rare, accounting for about 3% of all head and neck cancers.
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