Clinical Management of Metastatic Cervical Cancer of Unknown Primary

Metastatic cervical cancer of unknown primary (MCCUP) constitutes a challenging clinical entity for head and neck surgeons, which represents 3-5% of the total head and neck squamous cell carcinomas and 2-10% of the cases that proceed with palpable cervical lymph nodes. Usually, older male patients present with an asymptomatic, progressively enlarging neck mass, usually near the jugulodigastric lymph nodes. Despite the advancement of diagnostic modalities, such as PET/CT, endoscopy, US-FNAc, and biomarkers, some patients still have occult primary cancer with a controversial clinical management algorithm that is usually based on risk stratification. Early-stage disease is confronted with a single-modality treatment, preferably surgery, due to the staging potential, while advanced stages often require chemoradiation. The MCCUP treatment algorithm may shift toward precision medicine in the future, which offers accurate and individualized therapeutic outcomes.