CANCER OF UNKNOWN PRIMARY ORIGIN
James Bishop in Cancer Facts, 1999
Patients with cancer of unknown primary origin have atypical clinical presentations with sites of metastatic disease often differing from those with an obvious primary. Careful evaluation of these patients is indicated with an emphasis on histological characterisation, including use of special and immunocytochemical stains, electron microscopy and cytogenetics. Appropriate assessment of metastatic sites may define subgroups with potential for significant benefit from active therapy. Clinical investigations should be selective, with an emphasis on defining these specific subgroups of patients with responsive malignancies. An extensive search for the primary site of origin of the malignancy is rarely indicated. Surgery and radiotherapy is indicated for patients with metastatic disease localised to peripheral lymph nodes or with isolated lung and liver lesions. Chemotherapy is indicated for recog- nised sensitive histologies, including poorly differentiated malignant neoplasm and poorly differentiated carcinoma in selected clinical settings.
Paper 4
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw in The Final FRCR, 2020
A female patient is discussed at the cancer of unknown primary multidisciplinary team meeting. An MRI lumbar spine incidentally detected multiple liver lesions and several paraaortic lymph nodes measuring up to 15 mm in short axis. A malignant looking gastric lesion was subsequently identified on endoscopy.
Metastasis
John Melford in Pocket Guide to Cancer, 2017
Once a cancer spreads to other locations, it may be difficult to determine its site of origin. When this happens the growth is referred to as a cancer of unknown primary. Up to 5% of metastatic cancers belong to this category.
Predicting response to radiotherapy of head and neck squamous cell carcinoma using radiomics from cone-beam CT images
Published in Acta Oncologica, 2022
S. Sellami, V. Bourbonne, M. Hatt, F. Tixier, D. Bouzid, F. Lucia, O. Pradier, G. Goasduff, D. Visvikis, U. Schick
Patients with stage III–IV HNSCC following the 8th TNM classification treated with curative intent with definitive RT guided by weekly CBCTs, with or without chemotherapy (depending on age, performance status as well as comorbidities) between January 2014 and May 2017 were considered in this retrospective study. Among them, those with at least four CBCTs during treatment, including CBCT at week 1 were included. Patients who benefited from surgery of the primary tumor or those treated with palliative intent were excluded, as were patients with nasopharyngeal carcinoma, thyroid and salivary glands tumors or a different histology (melanoma and lymphoma). Patients with a cancer of unknown primary origin were also excluded. Patients who benefited from a neck dissection without surgical treatment on their primary tumor were considered.
The diagnostic challenges of patients with carcinoma of unknown primary
Published in Expert Review of Anticancer Therapy, 2020
Cancer of unknown primary (CUP) usually refers to a clinical entity that encloses a heterogeneous group of metastatic tumors without an identifiable primary after a complete diagnostic work-up [1]. This definition of CUP was initially inconsistent as some experts mandated a histologically proven biopsy and some others based their diagnosis on clinical findings without histologic confirmation [2,3]. The latter approach was quickly abandoned as the clinical perspective could not differentiate benign and malignant lesions. Moreover, the constellation of malignant lesions identified as CUP included epithelial and undifferentiated tumors only and excludes lymphomas and sarcomas, which eventually required a histologically proven cancer [1].
Presence of anti-transcriptional intermediary factor-1 gamma antibodies in a dermatomyositis patient with retroperitoneal cancer of unknown primary site
Published in Modern Rheumatology Case Reports, 2021
Hiroshi Hori, Yusuke Ozeki, Tsuyoshi Kobashigawa, Kazusige Futsuhara, Akira Tanaka, Eri Watanabe, Hiroki Yabe, Toru Yago, Takahiko Fukuchi, Hitoshi Sugawara, Shigeru Kotake
Based on skin symptoms associated with treatment-resistant skin myositis and anti-TIF1-γ antibody positivity, the current case was suspected to have a malignant tumour. However, despite repeated screening, no malignant tumour was found, leading to the onset of retroperitoneal cancer of unknown primary site. PET/CT scan may be useful even if no tumour is detected on general examination. Aggressive workup including biopsy is recommended for abnormal accumulation by PET-CT, especially in TIF1-gamma-positive cases. Furthermore, a thorough and repeated screening for tumours should be performed particularly after 3-5 years of diagnosis.
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