90% of unknown primary or occult primary, is in the oropharynx in the tonsil, mainly lingual or palantine, and base of tongue, as Bart mentioned. For OP usually a tonsillectomy is performed, sometimes bilaterally, including a neck dissection on the positive node finding side. Also as Bart mentioned a PET/CT scan is done, and a panendoscopy, under anesthesia, with biopsies. which was probably done during yout surgery.

The Tonsil, and BOT are difficult areas to detect with all the crevices, and the BOT more so due to its deep musculature, and both likely to metastasize due to the lymphatic tissue, and the tonsils are part of the lymphatic system.

There are several thoughts of unknown primaries, one if it was HPV related, it is usually small, and the nodal metastesee grows larger faster due to the blood, nutrients in surrounding tissue. The primary is small, undectsble by any scans or was missed in the biopsy. Another is when the primary metastasises, it takes all the nutrients, and blood with it, and primary dies off, and if HPV related, the body could have fought of the disease.

Most likely they will radiate the oropharynx as if the primary was there, in the waldeyer ring.

Good luck.





10/09 T1N2bM0 Tonsil
11/09 Taxo Cisp 5-FU, 6 Months Hosp
01/11 35 IMRT 70Gy 7 Wks
06/11 30 HBO
08/11 RND PNI
06/12 SND PNI LVI
08/12 RND Pec Flap IORT 12 Gy
10/12 25 IMRT 50Gy 6 Wks Taxo Erbitux
10/13 SND
10/13 TBO/Angiograph
10/13 RND Carotid Remove IORT 10Gy PNI
12/13 25 Protons 50Gy 6 Wks Carbo
11/14 All Teeth Extract 30 HBO
03/15 Sequestromy Buccal Flap ORN
09/16 Mandibulectomy Fib Flap Sternotomy
04/17 Regraft hypergranulation Donor Site
06/17 Heart Attack Stent
02/19 Finally Cancer Free Took 10 yrs