[Backache as main symptom of unknown primary cancer syndrome with a particularly severe course].
Explore the source record for details and available documents.
Acute Disease↗
SEARCH · Search PubMed
Results for “Cancer of unknown primary”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
RESPONSE OF PRIMARY UNKNOWN CANCERS TO TREATMENT WITH 5-FLUOROURACIL (NSC-19893).
Explore the source record for details and available documents.
Adolescent↗
Primary unknown cancer in pulmonary hilar lymph node with spontaneous transient regression: report of a case.
A 69-year-old man was referred to our hospital in December 1993 because an abnormal mass had been detected in the right pulmonary hilum. Computed tomography (CT) of the chest revealed a swollen hilar lymph node between the right middle and lower lobe bronchi, and an adherent tumor in the right ventrobasal segment (S8). Chest roentgenogram in February 1994, however, showed no evident tumor in the right lung field. In March 1996, the mass in the right pulmonary hilum reappeared on chest roentgenogram. Chest CT revealed a swollen hilar lymph node between the right middle and lower lobe bronchi, but there was no tumor in right S8. The patient underwent video-assisted thoracoscopy on 17 May 1996. Intraoperative needle biopsy of the node revealed cancer cells. We performed right middle and lower bilobectomy with mediastinal dissection. Histological diagnosis revealed a large cell carcinoma almost completely occupying a hilar lymph node. The resected middle and lower lobes showed no tumors, except for a coagulation necrosis measuring 1.5 cm in diameter in S8b, corresponding to the site where a tumor shadow had been depicted on the CT image in December 1993. We concluded that the coagulation necrosis might have been the primary site of the tumor, which had spontaneously regressed and then appeared in the metastatic interlobar node.
Aged↗
Cervical lymph node metastasis: unknown primary cancer.
Explore the source record for details and available documents.
Follow-Up Studies↗
Presentation of unknown primary cancer with metastatic liver disease--management and natural history.
Initial blind liver biopsy established a histological diagnosis of metastatic cancer in 27 out of 34 patients who presented with clinical signs of liver metastases and no obvious primary tumour. Twenty-two of the patients had metastatic adenocarcinoma, and a primary tumour site was identified before death in only four patients.
Adenocarcinoma↗
Ki-1 anaplastic large-cell lymphoma in the differential diagnosis of unknown primary cancer.
The importance of immunohistochemical analysis of anaplastic or undifferentiated carcinoma, especially in the setting of an unusual clinical presentation, is illustrated by two cases of metastatic undifferentiated carcinoma. Re-evaluation of pathological material resulted in a diagnosis of Ki-1 lymphoma and led to substantial alteration in therapeutic strategy and long-term outlook. The response to therapy was unusually favorable in both cases, and survival was prolonged in both. Archival pathological material was retrieved in order to perform special studies that were not originally available at the time of diagnosis, consisting of immunoperoxidase detection of hematological markers that are preserved in formalin-fixed, paraffin-embedded tissues. Both tumors were found in retrospect to actually represent anaplastic, Ki-1-positive, large-cell lymphoma. This neoplastic entity has been introduced to the oncologic literature only within the past decade. Because this neoplasm shows chemosensitivity and responsiveness similar to that of other large-cell lymphomas, we alert practitioners to consider this diagnosis in any patient who presents with an apparently metastatic undifferentiated tumor.
Adult↗
Positron emission tomography: useful in detecting metastatic cancer of unknown primary site.
Metastatic cancer of unknown primary site represents approximately three percent of all new cancer diagnoses. Expensive and invasive diagnostic procedures are often performed although the primary tumour is detected in less than 25 percent of cases. We present a 63-year-old woman presenting with low back pain and was found on positron emission tomography (PET) to have lung cancer. The pros and cons of PET in the diagnostic process of patients with metastatic cancer of unknown primary site are reviewed. PET should be considered in the diagnostic process of patients with unknown primaries, and unnecessary invasive procedures may be avoided.
Female↗
[Management of carcinomatous metastatic pleurisy with unknown primary neoplasm].
The primary cancer remains unknown in about 7% of all cases of metastatic carcinomatous pleurisy. Thoracoscopic pleural biopsy provide good quality histology material. The pathology examination, including immunohistochemistry using a panel of well-defined antibodies can provide the diagnosis of neoplastic pleurisy of malignant carcinomatous proliferation, and help search for differentiation and rule out an identifiable primary carcinoma. When histology does not provide a satisfactory clue to the primary cancer, frequent origins include lung cancer, breast or ovary cancer in women, prostate cancer in men, and digestive tract cancer. The possible contribution of positron emission tomography remains to be evaluated. Several chemotherapy protocols can be proposed but the beneficial effect has been difficult to assess due to the heterogeneous nature of the histological forms treated. The carboplatin-paclitaxel-etoposide protocol appears to be promising in cases with an unknown primary cancer but there has been no specific assessment of this chemotherapy schedule in a subgroups of patients with carcinomatous pleurisy with an unknown primary cancer. Better understanding of the biological profile of highly metastatic cancers should be helpful in determining more targeted therapeutic schemes.
Humans↗
Cancer of unknown primary: clinicopathologic correlations.
Cancer of unknown primary origin (CUP) accounts for 5-10% of all malignant tumors at presentation and remains the death certificate diagnosis in 0.5-5% of patients. We investigated CUP patients whose primary site remained unknown throughout the entire clinical course. We reviewed 9,436 consecutive autopsies performed between 1984 and 1999 at the Mayo Clinic, matched with 177,167 cancer patients treated in the same time period. Sixty-four patients who died of CUP underwent postmortem examination. Antemortem pathologic diagnoses were obtained in 57 patients, agreed with postmortem diagnoses in 98%, and included adenocarcinoma (n=44), undifferentiated carcinoma (n=7), squamous cell carcinoma (n=3), and others (n=3). Autopsy located the primary site in 35 patients (55%). Common primary sites were lung (n=8), the pancreaticobiliary (n=13) and GI tracts (n=9). Of 43 patients evaluated for tumor-specific therapy, only six received no further oncologic treatment and untreated patients survived a median of 57 (range 10-280) days, compared with 225 (range 19-1,129) days for patients treated with chemotherapy and/or radiotherapy (n=37). Our findings show that (1) autopsy studies provide a valuable tool for quality control in the setting of CUP, and (2) treated patients have a small but significant survival benefit.
Adenocarcinoma↗
Diagnostic and therapeutic management of cancer of an unknown primary.
Metastatic Cancer of Unknown Primary Site (CUP) accounts for approximately 3% of all malignant neoplasms and is therefore one of the 10 most frequent cancer diagnoses in man. Patients with CUP present with metastatic disease for which the site of origin cannot be identified at the time of diagnosis. It is now accepted that CUP represents a heterogeneous group of malignancies that share a unique clinical behaviour and, presumably, unique biology. The following clinicopathological entities have been recognised: (i) metastatic CUP primarily to the liver or to multiple sites, (ii) metastatic CUP to lymph nodes including the sub-sets involving primarily the mediastinal-retroperitoneal, the axillary, the cervical or the inguinal nodes, (iii) metastatic CUP of peritoneal cavity including the peritoneal papillary serous carcinomatosis in females and the peritoneal non-papillary carcinomatosis in males or females, (iv) metastatic CUP to the lungs with parenchymal metastases or isolated malignant pleural effusion, (v) metastatic CUP to the bones, (vi) metastatic CUP to the brain, (vii) metastatic neuroendocrine carcinomas and (viii) metastatic melanoma of an unknown primary. Extensive work-up with specific pathology investigations (immunohistochemistry, electron microscopy, molecular diagnosis) and modern imaging technology (computed tomography (CT), mammography, Positron Emission Tomography (PET) scan) have resulted in some improvements in diagnosis; however, the primary site remains unknown in most patients, even on autopsy. The most frequently detected primaries are carcinomas hidden in the lung or pancreas. Several favourable sub-sets of CUP have been identified, which are responsive to systemic chemotherapy and/or locoregional treatment. Identification and treatment of these patients is of paramount importance. The considered responsive sub-sets to platinum-based chemotherapy are the poorly differentiated carcinomas involving the mediastinal-retroperitoneal nodes, the peritoneal papillary serous adenocarcinomatosis in females and the poorly differentiated neuroendocrine carcinomas. Other tumours successfully managed by locoregional treatment with surgery and/or irradiation are the metastatic adenocarcinoma of isolated axillary nodes, metastatic squamous cell carcinoma of cervical nodes, or any other single metastatic site. Empirical chemotherapy benefits some of the patients who do not fit into any favourable sub-set, and should be considered in patients with a good performance status.
Diagnostic Imaging↗
Cancer from an unknown primary site.
Cancer from an unknown primary site (CUP) is frequently encountered in clinical practice. This review is designed to help physicians identify those patients with CUP that benefit from specific therapeutic approaches. The utility of pathologic and diagnostic tests in patients with CUP will also be discussed, as will the prognosis and appropriate treatment of these patients.
Humans↗
Functional outcome and survival after radiotherapy of metastatic spinal cord compression in patients with cancer of unknown primary.
PURPOSE: Patients with cancer of unknown primary (CUP) account for about 10% of patients with metastatic spinal cord compression (MSCC). This study aims to define the appropriate radiation regimen for these patients. METHODS AND MATERIALS: Data of 143 CUP patients irradiated for MSCC were retrospectively evaluated. Short-course radiotherapy (RT) (1x8 Gy, 5x4 Gy, n = 68) and long-course RT (10x3 Gy, 15x2.5 Gy, 20x2 Gy, n = 75) plus 8 further potential prognostic factors (age, gender, performance status, visceral metastases, other bone metastases, number of involved vertebrae, ambulatory status, time of developing motor deficits before RT) were compared for functional outcome and survival. RESULTS: Improvement of motor function occurred in 10% of patients, no further progression of motor deficits in 57%, and deterioration in 33%. On multivariate analysis, functional outcome was positively associated with slower development of motor deficits (p < 0.001), absence of visceral metastases (p = 0.008) and other bone metastases (p = 0.027), and ambulatory status (p = 0.054), not with the radiation regimen (p = 0.74). Recurrence of MSCC in the irradiated region occurred in 7 patients after median 6 months. Median survival was 4 months. On multivariate analysis, better survival was significantly associated with absence of visceral metastases (p < 0.001), absence of other bone metastases (p = 0.005), ambulatory status (p = 0.001), and slower development of motor deficits (p = 0.030). CONCLUSIONS: For MSCC treatment in patients with CUP, no significant difference was observed between short-course and long-course RT regarding functional outcome and survival. Short-course RT appears preferable, at least for patients with a poor predicted survival, as it is more patient convenient and more cost-effective.
Adult↗
Cancer of unknown primary: changing approaches. A multidisciplinary case presentation from the Joan Karnell cancer center of pennsylvania hospital.
Cancer of unknown primary is a common clinical syndrome, accounting for 2%-5% of cancer patients. A representative case is presented. This heterogenous group of disorders includes entities such as poorly differentiated carcinoma of unknown primary, adenocarcinoma of unknown primary, neuroendocrine carcinoma of unknown primary, squamous cell carcinoma of unknown primary, poorly differentiated (not otherwise specified) cancer of unknown primary, and melanoma of unknown primary. It is crucial to identify those treatment-responsive presentations of unknown primary with the greatest potential for long-term survival. This discussion emphasizes newer approaches to the diagnosis and treatment of unknown primary cancer, including advances in pathology with immunoperoxidase and molecular genetic techniques, positron emission tomography, and published chemotherapeutic trials. With the increased sophistication of pathologic and radiologic techniques, the frequency of unknown primary cancers will likely continue to decline. Further, as newer and more targeted therapies for specific types of cancer are identified, the previously held nihilism regarding the search for and identification of the primary may become less supportable.
Fatal Outcome↗
[Cancer of unknown primary site].
INTRODUCTION: Patients with cancer of unknown primary site represent 0.5 to 9 percent of all cancer patients with a major incidence in people aged 50 to 70 years. The most common histological diagnosis is adenocarcinoma. The vast majority of patients have at least two different metastatic sites involved at the moment of the diagnosis. Among the identified occult primaries lung and pancreas constitute the majority. Histological diagnosis, age, sex, performance status, tumor burden and organs involved are the most important prognostic factors. DIAGNOSIS: Complete medical history and physical examination are able to reveal symptoms and signs in more than 90 percent of patients. Routine laboratory tests, serum tumor markers, imaging studies and endoscopies will complete the diagnostic approach. The pathologic assessment of biopsied material is usually initiated by light microscopic examination: additional pathologic studies, including histochemistry, electron microscopy and genetic analysis are frequently and productively employed. THERAPEUTIC APPROACH: Locoregional treatment can be curative in a few and selected cases and is more often offered with a palliative intent. The elective treatment for metastatic disease is represented, in the vast majority of cases, by systemic chemotherapy with different schedules according to pathological diagnosis. Best supportive care is sometimes the best choice. CONCLUSIONS: It is recommended to treat such patients in the context of clinical trials.
Age Factors↗
[An analysis of autopsy cases with cancer of unknown primary site].
A retrospective review of autopsy cases with cancer of clinically unknown primary site seen at Shikoku Cancer Center Hospital from 1959 to 1992 was performed. Fifty three cases (3.1%) were registered as having cancer of unknown primary site among 1690 consecutive autopsy cases with malignancies except for leukemias and brain tumors. Major discrepancies on the primary site between the clinical diagnoses and the autopsy reports were present in 30 cases (1.8%). Twelve cases (0.7%) with malignancy of peritoneum or retroperitoneum primary were found that were clinically regarded as peritonitis carcinomatosa. Latent cancer, in which a new primary cancer was subsequently identified at autopsy, was recognized in 190 cases (11.2%). The mean age in latent cancer group was significantly higher than in control group, but patients with cancer of unknown primary site tended to be somewhat younger. A high male: female ratio was found in latent cancer group, whereas it was reverse in cases with clinically undetermined primary cancer. Survival overall was poor, with a median survival of 5 months. As diagnostic techniques (such as sonography, computerized tomography scanning and nuclear scans) have been improved, cases with cancer of unknown primary site have tended to decrease, but the percentage of cases presenting latent cancer has remained relatively stable over the years. Precise autopsy examination revealed that the primary sites of clinically undetermined cancers were ovary, pancreas, stomach, gallbladder and peritoneum in order of decreasing frequency. The metastatic pattern and histologic types were not different from that in the control group.
Aged↗
[The value of positron emission tomography (PET) in the treatment of patients with cancer of unknown primary (CUP)].
BACKGROUND: In patients with cancer of unknown primary median survival for localized disease is 20, for disseminated disease 7 months. After diagnostic procedures including MRI or endoscopy, the primary tumor is detected in less than 25%. In the study presented here the value of PET for detection of the primary tumor and a possible dissemination has been investigated and related to therapeutic regimens. PATIENTS AND METHODS: Between May 1998 and February 2001 a total of 52 patients with CUP syndrome, 18 females and 34 males, have been included. At first diagnosis, stage of disease was localized in 43 patients (35 lymphonodal, eight visceral), and disseminated in nine patients (Table 1). After a median of seven (range three to eleven) diagnostic procedures without detection of the primary tumor (Table 2) PET with fluorine-18-fluorodeoxyglucose was performed. RESULTS: Due to the PET result a primary tumor was suggested in 31/52 patients (60%), and confirmed in 21/52 patients (40%). In 16/43 patients (37%) with initially (before PET) localized disease dissemination was detected by PET only, despite various preceding diagnostic procedures (Figure 1). Overall, in 33/52 patients (63%) the PET result had major impact on selection of an individual treatment (Table 3), in case of initially localized disease in 30/43 patients (70%). CONCLUSION: In patients with CUP the PET result is not only of great value for detection of the primary tumor, but in case of initially localized disease also for diagnosis of a possible dissemination. The PET result often has relevant influence on therapeutic management.
Adult↗
Cancer of unknown primary site.
BACKGROUND: About 2% of more than 1 million cases of cancer diagnosed in residents of SEER areas for the 15-year period 1973-1987 were designated as being cancers of unknown primary site. METHODS: The 26,050 histologically diagnosed cancers of unknown primary site were studied. The small groups of other and ill-defined sites within the respiratory and intrathoracic systems and other ill-defined sites (546 total) were included in this total. RESULTS: Over the 15-year period, there has been a decrease in the number of these cancers for each race-sex group. There has been very little change over time in the distribution by histologic type. The most frequent diagnosis was adenocarcinoma (around 55%), with approximately equal numbers of epidermoid carcinoma and carcinoma, not otherwise specified (about 14%). Changes in the frequency of mucinous, small cell, and large cell carcinoma have been observed. Carcinoid tumors of unknown primary site increased substantially. CONCLUSION: The decline in the numbers of cancers assigned to unknown primary site is to be welcomed.
Adolescent↗
Cancer of Unknown Primary Origin.
About 3% of all cancer patients suffer from cancer of unknown primary origin. These patients present with metastatic disease for which a primary site cannot be detected at the time of diagnosis. Sophisticated diagnostic techniques and operational procedures have failed to improve the diagnostic efficacy in this group of patients. Consequently, a limited diagnostic procedure with basic laboratory tests and imaging studies is sufficient for the diagnosis of this syndrome. The use of immunohistochemistry, as well as serum tumor markers of high specificity that may help to identify other tumors, is highly suggested. Although the prognosis for the majority of these patients still remains poor, several subsets of favorable outcome to treatment have been recognized. Nevertheless, promising in vitro data and new drugs on trials, paralleled with a better knowledge of the underlying pathogenetic molecular mechanisms, offer a more optimistic look to the future therapeutic management of these patients.
Journal Article↗