Cervical lymph node metastasis from a remote primary site with an airway emergency

Cervical lymphadenopathy usually represents lymphomas or metastasis from head and neck primary tumors, but it can also occasionally be a manifestation of a remote primary site. PET-CT has improved identification of the location of such unknown primaries, particularly when they are distant in location. The mechanism, however, of head and neck metastases from many of these distant primary tumours remains obscure as there are often no obvious lymphatic pathways to explain their mode of spread. Cervical metastatic disease from a remote primary is often incurable and becomes even more challenging when the airway is compromised. Management of these cases is quite difficult and requires a multidisciplinary team. We report a rare case of a 45-year-old patient with a neck swelling and threatened airway due to metastatic breast cancer. The prognosis of breast cancer with distant metastases to the head and neck is generally poor, and the management of these lesions is controversial. Overall extent of the disease and individual patient prognosis must guide these treatment decisions.