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.
