Metastatic Squamous Neck Cancer with Occult Primary Treatment (Adult) (PDQ®)–Patient Version

When several areas of lymph nodes are swollen, that suggests the problem is throughout your body. It could be something like chickenpox, HIV, or a cancer such as leukemia or lymphoma.

Lymph nodes

This page was reviewed under our medical and editorial policy by Maurie Markman, MD, President, Medicine & Science at CTCA. This page was updated on June 24, 2022.

• What are lymph nodes?
• What do lymph nodes do?
• Where are lymph nodes located?
• Swollen lymph nodes: What do they mean?
• Diagnosing symptoms related to lymph nodes
• Lymph nodes and staging cancer
• Treatment for cancer in the lymph nodes

What are lymph nodes?

Lymph nodes are small, bean-shaped organs that produce and store blood cells and filter lymph fluid, helping to remove waste materials and harmful germs from your body. They house important immune cells that fight infection. About 600 lymph nodes are scattered throughout your body.

Each lymph node is connected to lymph vessels, or tiny tubes, that are similar to the veins in the cardiovascular system. Instead of blood, the lymphatic vessels carry a clear, watery fluid called lymph.

Because lymph nodes may be affected by medical conditions such as infection and cancer, and harmful cells will end up there, they can provide clues as to what’s going on inside your body. This is why a biopsy (removal of tissue) may be done on a lymph node—to collect cells and examine them under a microscope.

What do lymph nodes do?

Lymph nodes play numerous roles within the very complex lymph system. The lymph system is part of the body’s immune system, producing white blood cells—B lymphocytes (B cells) or T lymphocytes (T cells)—that fight infection by killing harmful cells. The lymph system also includes the tonsils, spleen and thymus.

In the U.S., healthcare spending accounts for 17.7% of the Gross Domestic Product (GDP), or the total value of goods and services produced by the entire nation for the entire year, according to the Centers for Medicare & Medicaid Services.

The lymphatic fluid that flows through the vessels to the lymph nodes brings oxygen and nutrients to tissue cells and takes away waste products from the cells.

The lymph fluid filtered by the lymph nodes, no matter where they’re located, moves to the chest and recirculates back into the bloodstream. Each group of lymph nodes filters a specific region of the body.

Where are lymph nodes located?

Some of the hundreds of lymph nodes are single nodes, while others are in groups called chains. Though they’re found throughout your body and are connected in a sophisticated network, there are large concentrations of lymph nodes in the following key areas:

• Neck (cervical lymph nodes)
• Armpits (axillary lymph nodes)
• Chest (thoracic lymph nodes)
• Abdomen (lymph nodes of the large intestine and lower abdomen, among others)
• Groin (inguinal lymph nodes)

Swollen lymph nodes: What do they mean?

Swollen lymph nodes, or swollen glands, are a symptom of many illnesses—from the common cold to some forms of cancer—and a sign that something is wrong in the body. The swelling or enlargement, called lymphadenopathy, occurs in the lymph nodes when they’re filtering cells affected by a condition, such as an infection, injury or cancer. The most common reason lymph nodes swell is because of an infection, particularly viral infections such as a cold. It’s much rarer for swollen lymph nodes to be a symptom of a more serious condition such as cancer.

The lymph nodes are likely to swell in one specific region depending on the illness. This will usually occur in the neck, armpits or groin. Less common is when lymph nodes swell in several regions at the same time. That condition may be brought on by infections such as strep throat or mononucleosis, a reaction to certain medicines, an immune system disorder such as rheumatoid arthritis, and forms of cancer such as lymphoma and leukemia.

When lymph node swelling persists and is accompanied by other symptoms, such as fever or night sweats, or when there’s no obvious infection, it may be time to seek medical advice or evaluation from a doctor.

Diagnosing symptoms related to lymph nodes

When touching an affected area, swollen lymph nodes may feel soft and round, like lumps the size of a pea, peanut or grape. If they’re painful when touched, that may be a sign of inflammation. Since lymph nodes appear in parallel—as, for instance, on both sides of the neck—you can feel lymph glands on both sides to see whether they are a normal size on one side and enlarged on the other, which may be a sign of infection.

In determining a diagnosis, it’s important for doctors to look at other symptoms or factors. Swollen lymph nodes near the ear may indicate an ear infection, for instance. Swollen glands in the neck area near the collarbone, combined with a sore throat and cough, may be a sign of an upper respiratory infection. When multiple regions of lymph nodes are swollen, it may indicate a body-wide disease that needs immediate attention.

Besides reviewing your medical history, doctors may use some of the following methods to diagnose the cause of swollen lymph nodes:

• Physical examination, feeling with fingers the nodes in the affected area to check their size and whether they feel hard, tender or warm
• Lab tests, including blood tests to check for suspected underlying conditions
• Imaging tests, including an X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI) or ultrasound test
• Biopsy to remove sections of lymph tissue or an entire lymph node to examine under a microscope

Cancer in the lymph nodes

In rare cases, lymph node swelling may be related to cancer. Some cancers start in the lymph nodes. Non-Hodgkin lymphoma and Hodgkin lymphoma are types of lymph system cancers, as is acute lymphocytic leukemia.

More often, a cancer may appear in the lymph nodes as a metastasis, spreading from somewhere else in the body. Some cancer cells break off from a tumor and metastasize in another location. Those cancer cells may travel through the bloodstream and reach other organs, or go through the lymph system and reach lymph nodes. However, most of the cancer cells traveling through the bloodstream or lymph system will die or be killed off before they have a chance to metastasize, according to the American Cancer Society (ACS).

When cancer is present in a lymph node, a biopsy helps determine what type of cancer it is when the removed tissue or node is examined under a microscope. The cancer cells will look like the cancer cells of the tumor where they originated, so breast cancer cells in the lymphatic system will still look like breast cancer.

Lymph nodes and staging cancer

Oncologists use cancer staging to determine the extent of cancer in the body. Lymph nodes play an important role in one of the most commonly used staging systems, called TNM. The TNM system is based on the extent of the tumor (T), how much it has spread to nearby lymph nodes (N) and the presence of metastasis (M). Each letter is assigned a numerical value based on clinical observations.

If no cancer is found in the lymph nodes near the cancer, the N is assigned a value of 0. If nearby or distant nodes show cancer, the N is assigned a number that increases based on the number of nodes affected, the size and extent of the cancer, how large the nodes are and where they’re located. The numbers for each initial are added up. The higher the sum, the more advanced the cancer. The lower the TNM score, the easier it may be to treat.

Treatment for cancer in the lymph nodes

Treatment for cancer in the lymph nodes varies depending on the tumor size and location and whether the cancer has metastasized to other areas of the body.

Surgery may be used to treat some forms of metastatic cancer that has spread to the lymph nodes. Other treatment options for cancer in the lymph nodes may include chemotherapy, radiation therapy, a stem cell transplant, immunotherapy or targeted therapy.

There’s a higher risk for cancer to come back following surgery when a cancer has spread to lymph nodes. In those cases, chemotherapy or radiation therapy may be recommended after surgery.

Removing lymph nodes during cancer surgery is “highly unlikely” to weaken the patient’s immune system, because it is “large and complex and is located throughout the body,” the ACS says. Lymph node removal may leave the affected part of the body unable to drain off lymph fluid, which may lead to a fluid backup (lymphedema) and may become a continuing problem. The greater the amount of lymph nodes removed, the greater the chance for lymphedema to occur.

Metastatic Squamous Neck Cancer with Occult Primary Treatment (Adult) (PDQ®)–Patient Version

General Information About Metastatic Squamous Neck Cancer with Occult Primary

Key Points

• Metastatic squamous neck cancer with occult primary is a disease in which squamous cell cancer spreads to lymph nodes in the neck and it is not known where the cancer first formed in the body.
• Signs and symptoms of metastatic squamous neck cancer with occult primary include a lump or pain in the neck or throat.
• Tests that examine the tissues of the neck, respiratory tract, and upper part of the digestive tract are used to detect (find) and diagnose metastatic squamous neck cancer and the primary tumor.
• Certain factors affect prognosis (chance of recovery) and treatment options.

Metastatic squamous neck cancer with occult primary is a disease in which squamous cell cancer spreads to lymph nodes in the neck and it is not known where the cancer first formed in the body.

Squamous cells are thin, flat cells found in tissues that form the surface of the skin and the lining of body cavities such as the mouth, hollow organs such as the uterus and blood vessels, and the lining of the respiratory (breathing) and digestive tracts. Some organs with squamous cells are the esophagus, lungs, kidneys, and uterus. Cancer can begin in squamous cells anywhere in the body and metastasize (spread) through the blood or lymph system to other parts of the body.

When squamous cell cancer spreads to lymph nodes in the neck or around the collarbone, it is called metastatic squamous neck cancer. The doctor will try to find the primary tumor (the cancer that first formed in the body), because treatment for metastatic cancer is the same as treatment for the primary tumor. For example, when lung cancer spreads to the neck, the cancer cells in the neck are lung cancer cells and they are treated the same as the cancer in the lung. Sometimes doctors cannot find where in the body the cancer first began to grow. When tests cannot find a primary tumor, it is called an occult (hidden) primary tumor. In many cases, the primary tumor is never found.

Signs and symptoms of metastatic squamous neck cancer with occult primary include a lump or pain in the neck or throat.

Check with your doctor if you have a lump or pain in your neck or throat that doesn’t go away. These and other signs and symptoms may be caused by metastatic squamous neck cancer with occult primary. Other conditions may cause the same signs and symptoms.

Tests that examine the tissues of the neck, respiratory tract, and upper part of the digestive tract are used to detect (find) and diagnose metastatic squamous neck cancer and the primary tumor.

Tests will include checking for a primary tumor in the organs and tissues of the respiratory tract (part of the trachea), the upper part of the digestive tract (including the lips, mouth, tongue, nose, throat, vocal cords, and part of the esophagus), and the genitourinary system.

The following procedures may be used:

• Physical exam and health history: An exam of the body, especially the head and neck, to check general signs of health. This includes checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist or tested in the laboratory to check for signs of cancer. Three types of biopsy may be done:

• Fine-needle aspiration (FNA) biopsy: The removal of tissue or fluid using a thin needle.
• Core needle biopsy: The removal of tissue using a wide needle.
• Excisional biopsy: The removal of an entire lump of tissue.

The following procedures are used to remove samples of cells or tissue:

• Tonsillectomy: Surgery to remove both tonsils.
• Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through an incision (cut) in the skin or opening in the body, such as the mouth or nose. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove abnormal tissue or lymph node samples, which are checked under a microscope for signs of disease. The nose, throat, back of the tongue, esophagus, stomach, voice box, windpipe, and large airways will be checked.

One or more of the following laboratory tests may be done to study the tissue samples:

• Immunohistochemistry: A laboratory test that uses antibodies to check for certain antigens (markers) in a sample of a patient’s blood or bone marrow. The antibodies are usually linked to an enzyme or a fluorescent dye. After the antibodies bind to a specific antigen in the blood or bone marrow, the enzyme or dye is activated, and the antigen can then be seen under a microscope. This type of test is used to help diagnose cancer and to help tell one type of cancer from another type of cancer.
• Light and electron microscopy: A test in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.
• Epstein-Barr virus (EBV) and human papillomavirus (HPV) test: A test that checks the cells in a sample of tissue for EBV and HPV DNA.

A diagnosis of occult primary tumor is made if the primary tumor is not found during testing or treatment.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis and treatment options depend on the following:

• The number and size of lymph nodes that have cancer in them.
• Whether the cancer has responded to treatment or has recurred (come back).
• How different from normal the cancer cells look under a microscope.
• The patient’s age and general health.

Treatment options also depend on the following:

• Which part of the neck the cancer is in.
• Whether certain tumor markers are found.

Stages of Metastatic Squamous Neck Cancer with Occult
Primary

Key Points

• After metastatic squamous neck cancer with occult primary has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body.
• There are three ways that cancer spreads in the body.
• Metastatic squamous neck cancer with occult primary can recur (come back) after it has been treated.

After metastatic squamous neck cancer with occult primary has been diagnosed, tests are done to find out if cancer cells have spread to other parts of the body.

The process used to find out if cancer has spread to other parts of the body is called staging. There is no standard staging system for metastatic squamous neck cancer with occult primary.

The results from tests and procedures used to detect and diagnose the primary tumor are also used to find out if cancer has spread to other parts of the body.

The tumors are described as untreated or recurrent. Untreated metastatic squamous neck cancer with occult primary is cancer that is newly diagnosed and has not been treated, except to relieve signs and symptoms caused by the cancer.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Metastatic squamous neck cancer with occult primary can recur (come back) after it has been treated.

The cancer may come back in the neck or in other parts of the body.

Treatment Option Overview

Key Points

• There are different types of treatment for patients with metastatic squamous neck cancer with occult primary.
• Two types of standard treatment are used:
  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Hyperfractionated radiation therapy

  There are different types of treatment for patients with metastatic squamous neck cancer with occult primary.

  Different types of treatment are available for patients with metastatic squamous neck cancer with occult primary. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

  Two types of standard treatment are used:

  Surgery

  Surgery may include neck dissection. There are different types of neck dissection, based on the amount of tissue that is removed.

  • Radical neck dissection: Surgery to remove tissues in one or both sides of the neck between the jawbone and the collarbone, including the following:
  • All lymph nodes.
  • The jugular vein.
  • Muscles and nerves that are used for face, neck, and shoulder movement, speech, and swallowing.

  After the doctor removes all the cancer that can be seen at the time of surgery, some patients may be given radiation therapy after surgery to kill any cancer cells that are left. Treatment given after surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

  Radiation therapy

  Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. Intensity-modulated radiation therapy (IMRT) is a type of 3-dimensional (3-D) external radiation therapy that uses a computer to make pictures of the size and shape of the tumor. Thin beams of radiation of different intensities (strengths) are aimed at the tumor from many angles. This type of radiation therapy is less likely to cause dry mouth, trouble swallowing, and damage to the skin.

  Radiation therapy to the neck may change the way the thyroid gland works. Blood tests may be done to check the thyroid hormone level in the body before treatment and at regular checkups after treatment.

  New types of treatment are being tested in clinical trials.

  This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.

  Chemotherapy

  Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy).

  Hyperfractionated radiation therapy

  Hyperfractionated radiation therapy is a type of external radiation treatment in which a smaller than usual total daily dose of radiation is divided into two doses and the treatments are given twice a day. Hyperfractionated radiation therapy is given over the same period of time (days or weeks) as standard radiation therapy.

  Treatment for metastatic squamous neck cancer with occult primary may cause side effects.

  For information about side effects caused by treatment for cancer, see our Side Effects page.

  Patients may want to think about taking part in a clinical trial.

  For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

  Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

  Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

  Patients can enter clinical trials before, during, or after starting their cancer treatment.

  Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

  Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

  Follow-up tests may be needed.

  Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

  Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

  Treatment of Untreated Metastatic Squamous Neck Cancer with Occult Primary

  For information about the treatments listed below, see the Treatment Option Overview section.

  Treatment of untreated metastatic squamous neck cancer with occult primary may include the following:

  • Radiation therapy.
  • Surgery.
  • Radiation therapy followed by surgery.
  • A clinical trial of chemotherapy followed by radiation therapy.
  • A clinical trial of chemotherapy given at the same time as hyperfractionated radiation therapy.
  • Clinical trials of new treatments.

  Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

  Treatment of Recurrent Metastatic Squamous Neck Cancer with Occult Primary

  For information about the treatments listed below, see the Treatment Option Overview section.

  Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

  To Learn More About Metastatic Squamous Neck Cancer with Occult Primary

  For more information from the National Cancer Institute about metastatic squamous neck cancer with occult primary, see the following:

  • Carcinoma of Unknown Primary Home Page
  • Head and Neck Cancer Home Page
  • Oral Complications of Chemotherapy and Head/Neck Radiation
  • Metastatic Cancer

  For general cancer information and other resources from the National Cancer Institute, see the following:

  • About Cancer
  • Staging
  • Chemotherapy and You: Support for People With Cancer
  • Radiation Therapy and You: Support for People With Cancer
  • Coping with Cancer
  • Questions to Ask Your Doctor about Cancer
  • For Survivors and Caregivers

  About This PDQ Summary

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