Introduction :
Carcinoma of unknown primary (CUP) in the head and neck region remains a persistent and complex challenge for clinicians worldwide. Significant advances in diagnostic modalities such as cross-sectional imaging, molecular diagnostics, robotic surgery, and positron emission tomography (PET) have improved the ability to identify primary sites, especially within the oropharynx, notably HPV-related cancers.1,2
With the rising incidence of HPV-associated oropharyngeal carcinomas, the proportion of CUP cases presenting with regional metastases and occult primaries is also increasing, emphasizing the need for updated management strategies.3
Definition and Historical Background :
CUP is a heterogeneous disease characterized by metastatic cervical lymph nodes with no identifiable primary tumor despite thorough evaluation efforts.4
In many cases, these were presumed to involve ?branchiogenic carcinoma? ? a controversial and largely unsupported concept, since many series failed to meet the classical criteria established by Hayes Martin.5
It is now recognized that a significant portion of patients represent metastatic carcinoma from occult primaries, primarily within the oropharynx.6