In this section: Unknown Primary Cancer

CANCER of an unknown primary
treatment


What do we mean by 'Cancer of an Unknown Primary'? Cancer of Unknown Primary in the head and neck region occurs when the origin of the cancer is unknown, but is found to have spread to the lymph nodes in the neck. If it's not the cancer type you're looking for, please explore the information about other types of Head and Neck Cancers.


 
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​1. Treatment options for Cancer of Unknown Primary

Your cancer care team will discuss the treatment options available for treating Cancer of Unknown Primary. This is also a good time to consider if you would like a second opinion.

The treatment most suited to each person depends on many factors, including: 

  • the number and size of the lymph nodes that are affected

  • personal factors  (e.g. age, general health and treatment history)

  • treatments available (and whether any clinical trials are available)

  • your preferences for treatment. 

The treatment options for Cancer of Unknown Primary are:

  • Surgery (often combined with radiotherapy and chemotherapy)

  • Radiation therapy (often combined with chemotherapy)


2. Surgery for Cancer of Unknown Primary

Some common types of surgery that can be used for Cancer of Unknown Primary in the head and neck area are:
 

NECK DISSECTION

This involves removing the enlarged cancerous lymph nodes, together with other lymph nodes in the same region of the neck. 
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TONSILLECTOMY

This involves removing the tonsils, if there are signs of cancer in the tonsils or other lymph nodes in the neck. It can also help with diagnosing the type of cancer.
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How can I prepare for the surgery?

Your doctor will explain details of the surgery, general risks and side effects of surgery. Ask your doctor if you have questions. They may recommend:

  • stopping blood thinners (e.g. aspirin) before surgery to reduce the risk of bleeding

  • special stockings to reduce the risk of blood clots

  • early mobilisation (i.e not staying in bed) to reduce the risk of blood clots and chest infection

  • antibiotics to lower the risk of wound infection.

Before starting treatment, it is important that you consider stopping smoking to reduce the risk of infection and help you fully recovery after your treatment.

Side effects of surgery

Treatment for cancer of unknown primary may lead to a number of side effects. You may not experience all of the side effects. Speak with your doctor if you have any questions or concerns about treatment side effects.

3. Radiation Therapy for Cancer of Unknown Primary

For Cancer of Unknown Primary, radiation therapy may be used to treat the lymph nodes affected by cancer with or without the primary site(s) that it may likely have come from. The most common approach for cancer of unknown primary is called external beam radiation. This is where the radiation is applied from outside of the body.

Radiation therapy can be used in the following ways:

Definitive

This is when radiation therapy is used on its own without surgery. Definitive radiation therapy may be targeted to one side of the neck area (unilateral), containing the cancerous lymph nodes, or both sides of the throat (bilateral) to treat all possible areas of primary cancer. Typically, radiation therapy is delivered daily (but not on weekends) over 7 weeks. Chemotherapy may be added to the radiation therapy (chemoradiation)

Adjuvant

This is when radiation therapy is given after surgery and is used as an additional treatment to kill any cancer that may not have been removed during surgery. Adjuvant radiation therapy may also be given in combination with chemotherapy (called chemoradiation).

Palliative

In cases where a cure is not possible, radiation therapy is used to relieve symptoms of advanced cancer of unknown primary. Symptoms that may require palliative radiation therapy include pain, bleeding, breathing and swallowing difficulties.

How do I prepare for radiation therapy? 

You will meet with many members of the cancer care team, who will help you learn how to look after yourself through radiation therapy, recovery and long term follow-up. They will also talk to you about side effects and how to manage them. It may be helpful to write down questions as they come up, so you can ask anyone in your cancer care team when you see them.

 

Radiation therapy mask-making and simulation 

  • Radiation therapy is a precise treatment. In order to make sure, that the cancer is covered by the treatment, you will need to be very still during the treatment, usually for about five minutes. A radiation therapy mask that is made to fit perfectly to your shape, will be put on you during each treatment to help the machine target where the cancer is.
  • You will have a planning CT scan (and sometimes other scans) with the mask on. Your radiation oncologist and radiation therapists will use these scans with all your other clinical information to develop a radiation therapy plan just for you (a personalised plan). Your plan will be checked by the radiation therapy and radiation oncology physics team before it is ready to be used for your treatment. This whole process can take approximately 2-3 weeks.
 

Teeth and mouth care

You might need to have some of your teeth taken out, this will depend on the area being treated and the dose of radiation therapy. It is important to take out any broken or infected teeth before radiation therapy. Taking out unhealthy teeth after radiation therapy can cause problems with the jaw bone. Further information about removing teeth and what to expect before and after the operation is available here

 

 

Diet and nutrition 

Your cancer and its treatment can make it hard to eat and drink. Your doctor will recommend you see a dietitian to maximise your nutrition during treatment as well as while you are recovering. Sometime feeding tubes may be recommended depending on the area being treated and the dose of radiation therapy.
There are two common types of feeding tubes: 

  • Gastrostomy tube (sometimes called a PEG tube): this type of tube is inserted through your abdominal wall into your stomach, with part of the tube staying outside the stomach.  A syringe can be attached to the tube to give you food this way if needed. The tube is inserted using a camera through the mouth into the stomach (gastroscopy) or using a CT scanner to guide insertion directly through the skin. If a PEG tube is needed, your doctor will organise this before starting your radiation therapy

  • Nasogastric tube: this type of tube goes through the nose down into the stomach and is usually used for short periods (days or weeks). A nasogastric tube can be inserted at any time (before, during or after treatment).

 
 

Speech, voice and swallowing
 

Your cancer and its treatment can make swallowing and speech difficult. Your doctor will recommend you see a speech pathologist, who can help you with ways to manage swallowing and communication difficulties, during and after treatment.

 

 

There are many other aspects of supportive care that are available, ask your doctor if you have any specific needs.

Side effects

The side-effects of radiation therapy start around two weeks into treatment and progress through treatment to peak in the last week or just after treatment ends. The side effects start to improve 2-3 weeks after the end of treatment.

Side effects associated with radiation therapy depend on:
  • the dose of radiation therapy

  • the area being treated

  • whether or not chemotherapy is added to the radiation.

Each individual responds to radiation therapy differently. Some people may experience a few side effects while others may not experience any at all.

The following are some common side effects of radiation therapy:
  • tiredness

  • skin irritation in the treated area e.g. redness, dryness and itching, weeping skin, scaling or sometimes skin breakdown (sores)

  • dry mouth and throat due to lack of saliva (called xerostomia)

  • ulcers in the mouth or throat that make it painful or difficult to chew or swallow

  • altered taste, which is usally a loss of taste or sometimes an unpleasant taste in the mouth

  • pain on swallowing or difficulty with swallowing.​

Most side effects are short lived and may go away within 4–6 weeks of finishing radiation therapy. Some side effects may last for months after you finish radiation therapy and some may be permanent.

Once your radiation therapy ends, you will have regular follow-up appointments so your cancer care team can check your recovery and monitor any side effects that you may have. Your doctor may recommend some specific supportive care options to help during your recovery, such as help with changes in diet, teeth and mouth care and speech or swallowing



To learn more about Radiation Therapy and to watch
a video of an Immobilisation Maks being made click here



Immobilisation-Mask.png

4. Chemotherapy for Cancer of Unknown Primary

Chemotherapy works by destroying or damaging cancer cells. For head and neck cancers, chemotherapy is usually given into a vein through a needle with a catheter (tube) attached.

Usually chemotherapy is used in combination with radiation therapy to make the radiation therapy more effective. It is usually given once a week or once every 3 weeks throughout the duration of radiation therapy. Unlike chemotherapy for many other cancers, most patients do not lose their hair or have severe nausea and vomiting.

Side effects 

The side effects of chemotherapy depend on the medication used and how much you are given by your doctor (the dose). The most common medications used are called cisplatin, carboplatin and cetuximab. 

Each person responds to chemotherapy differently. Some people may experience a few side effects while others may not experience any at all.
​The following are common side effects of chemotherapy: 
  • nausea and vomiting

  • loss of feeling in the fingers and toes

  • some medications may cause kidney damage

  • hearing loss/thinning

  • ringing in the ears

  • rash

  • higher risk of infection (if the chemotherapy reduces the number of white cells in the blood)

Most of these side effects are short lived and may go away once you finish chemotherapy. Some side effects can take months or years to improve or may be permanent.

Once your treatments end, you will have regular follow-up appointments so that your doctor can check your recovery, make sure the cancer has not returned and monitor and treat any side effects that you may have.

PRINT
All the information in this section is available in a PDF.
Download it here.
IN THIS SECTION
  • What is Cancer of Unknown Primary?
  • What are Lymph Nodes?
  • What causes Cancer of Unknown Primary?
  • Signs and Symptoms of Cancer of an Unknown Primary
  • Tests for Cancer of an Unknown Primary?
  • Treatment options for Cancer of Unknown Primary
  • Surgery 
  • Radiation Therapy
  • Chemotherapy
 
FURTHER INFORMATION
  1. Head and Neck Cancer Australia Resources 
  2. External Links to other Head and Neck Cancer Resources