Hi, may I answer your health queries right now ?  Please type your query here... Hello,  my brother has stage iv squamous cell carcinoma, primary is unknown.  He is having surgery on his neck to remove the tumor and send to pathology for further testing and I guess to find the primary site of his metastasis.  What should I expect?  I have some medical knowledge.  Thank you
Hi ...it can be an unknown primary with secondaries in neck. You should ideally go for a PET scan to locate the site of primary which is the best investigation. However if you can't spend that much, you should visit an ENT surgeon to get a pan endoscopy (esophagoscopy, nasal endoscopy, DL copy, bronchoscopy ) done to assess all the primary sites of cancer. You will also have to undergo blind biopsies from sites like hypopharynx and tonsillectomy which are the sites for hidden carcinoma. Squamous cell carcinoma mean it will be mostly from head and neck region especially hypopharynx or oral cavity or upper GI tract. If you get evaluated in a manner the way I told you will definitely get the primary site. All the best.