Web MD

I'm a tad embarrassed to report that the most comprehensive and accessible report I've found on what I've got is on Web MD, or its affiliate, emedicine. Kind of obvious. But I'm glad to find it. It's at http://emedicine.medscape.com/article/848892-overview.

Here is a key section on where I am:

"This section targets the treatment of patients without an identifiable primary lesion of the head and neck after a thorough examination of the head and neck, a panendoscopy, and possible neck dissection. Jesse et al demonstrated the added advantage of radiation therapy to locoregional control following the surgical removal of cervical metastases. Patients with metastatic cervical lymphadenopathy (N1-N3) had a locoregional failure rate of 13-32% when treated with surgery alone. Compare this with the locoregional failure rate of 0-18% associated with primary surgery (neck dissection) followed by adjuvant external beam radiotherapy. The research following this study further demonstrated the improvement in locoregional control of patients with occult primary squamous cell carcinoma.

"Although the value of radiation therapy has been confirmed, the field to be covered by the radiation therapy is controversial. Grau et al demonstrated the improvement of locoregional control of cancer with bilateral neck irradiation versus ipsilateral irradiation. Patients treated with ipsilateral irradiation had a relative risk of recurrence in the head and neck of 1.9 compared with patients treated with bilateral irradiation. With further research, bilateral cervical irradiation with surgical therapy improves locoregional control of cancer and is accepted as the standard of care for patients with advanced cervical disease .

"The entire pharyngeal axis is generally accepted as the mucosal sites to be included in the radiation field in patients with occult primary lesions. Theoretically, this should prevent the occurrence of the primary lesion. In order to decrease the morbidity of radiation induced xerostomia, some practitioners would not include the nasopharynx within the radiation field if the results of the endoscopy and the findings on imaging studies are negative." [All footnotes omitted]

Xerostomia, for those who don't already know, is the big-time dry mouth that you get when radiation knocks out the salivary function.

Anyway... I now have a little better feel for where I will be going on the Second Opinion Trail. With luck (I guess you call it luck) I will be at MD Anderson at the next few days.

Spooky stuff, though. Another excerpt from emedicine:

"With multimodality treatment, locoregional control of the cancer has improved in this patient population, but little improvement has occurred in overall disease-free survival. The 3- and 5-year disease-free survival rates are 40-60% and 10-25%, respectively. Prognostic factors include nodal stage at presentation, extracapsular spread, and tumor differentiation."

Let's hope that the modifier "disease-free" is what's important. We may well eventually find the mysterious primary cancer. If we do, we will knock it down, and its progeny, every time, until they stay down on the canvas for good.