Certain rules have been recommended for a number of specific presentations of CUPS.
"Midline" Tumors
These tumors originate in the middle part of the body such as the mediastinum (chest) or midabdominal lymph nodes. Some people with these tumors who are under 50 years of age, have lung and lymph node metastases and have a poorly differentiated histology respond well to combination chemotherapy that contains cisplatin and etoposide .
Sixty percent of the patients in one such group had a significant response to therapy and 15 percent were apparently cured. Some of these patients had blood or tissue markers (HCG or AFP) suggesting that they had a germ cell tumor.
CUPS in the Neck Lymph Nodes
When epidermoid (squamous) carcinoma is found in the neck (upper cervical) lymph nodes, patients should be treated as if they had a tumor of the upper respiratory area even though a thorough ear, nose and throat evaluation, including blind biopsies of the base of the tongue and the nasopharynx , may have been negative.
Treatment is potentially curative and may include:
• Radical radiotherapy to the cervical lymph nodes.
• Surgery to remove the lymph node group involved.
