Diagnosis,Management And Prognosis Of Unknown Primary Cervical Metastatic Carcinoma(with Five Cases Report)

Objective: 1 study the optimal approach of diagnosis of unknown primary cervical metastatic carcinoma to improve the detection rate of primary site; 2 study the particular form of treatment to enhance the treatment outcome of unknown primary cervical metastatic carcinoma.Method: Retrospective analysis of five case of cervical metastatic carcinoma of unknown primary site in our hospital diagnosis and treatment from January 2007 to January 2016, analysits clinical manifestations, diagnosis, selection of treatment and follow-up situation, as well as review of the literature.Results: This group of cases took in four males and one female patients and their age is between 26-71 years old(average age is 50 years old). The initial symptoms were expressed as a simple painless progressive increase neck mass, duration of time ranging from 20 days to 20 years. They had no history of malignancy and unknown surgery.In those cases, one case visited department of stomatology firstly, and the remaining cases were referred from outside the hospital. There was no unified specification to inspect simple painless progressive increase neck mass. They did one or more of the following checks: the serum tumor markers, EB virus, ultrasound check, thoracic and abdominal CT, nasopharyngeal CT, electronic nasopharyngoscopy and biopsy, whole body PET / CT; but they all did the neck tumor excision biopsy. When the initial diagnosis was cervical metastatic carcinoma of unknown primary site, the treatment of choice in this group of patients is not the same: one cases of first neck dissection, postoperative neck radiotherapy; one case the line "neck mass resection " and chemotherapy; a routine neck tumor resection that was discharged pathology results after return check electronicnasopharyngoscopy and biopsy and diagnosed "nasopharyngeal carcinoma" at last, so did radiotherapy; two patients refused to continue to find the primary tumor and treatment, but required continue to observe. Followed up for 2 months-18 months, two cases have not found the primary tumor; one case of abnormal tongue color at the time of follow-up four months, after the biopsy confirmed the "tongue cancer"; one case was loss of follow-up.Conclusions: Unknown primary cervical metastatic carcinoma diagnosis and treatment has been one of the problems in clinical work, the incidence of various statistical inconsistencies. Simple neck progressive increase painless lump is the only clinical symptom. By detailed collecting history,careful physical examination and according to the characteristics of the position of metastases, select pertinently the most commonly used laboratory examinations, cervical metastatic carcinoma primary tumor most can be found. In order to find the primary tumor, can do body PET / CT, associated endoscopic check, biopsy suspicious lesions and other tests. When primary tumors is still uncertain, can according to the original site first unknown neck metastatic carcinoma in the corresponding treatment, at the same time to do a good job of follow-up observation. Once found in the process of follow-up primary tumors, namely according to the corresponding disease treatment.Although CCUP overall prognosis is poor, but through the standard diagnosis and treatment, early identification of the primary tumor, tobacco and alcohol, anti-HPV infection, may have a better prognosis.