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Cancer of unknown primary site Cancer of unknown primary site
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Introduction Introduction
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Definition Definition
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Pathology Pathology
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Clinical approach Clinical approach
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Clinical picture and special investigations Clinical picture and special investigations
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Favourable subsets Favourable subsets
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Women with adenocarcinoma involving only axillary lymph nodes Women with adenocarcinoma involving only axillary lymph nodes
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Women with papillary adenocarcinoma of peritoneal cavity Women with papillary adenocarcinoma of peritoneal cavity
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Poorly differentiated carcinoma with midline distribution (extragonadal germ cell syndrome) Poorly differentiated carcinoma with midline distribution (extragonadal germ cell syndrome)
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Squamous cell carcinoma involving cervical or supraclavicular lymph nodes Squamous cell carcinoma involving cervical or supraclavicular lymph nodes
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Poorly differentiated neuroendocrine carcinomas Poorly differentiated neuroendocrine carcinomas
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Men with osteoblastic bone metastases and elevated PSA with adenocarcinoma histology Men with osteoblastic bone metastases and elevated PSA with adenocarcinoma histology
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Isolated inguinal lymphadenopathy from squamous cell carcinoma Isolated inguinal lymphadenopathy from squamous cell carcinoma
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Patients with a single metastatic site Patients with a single metastatic site
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Unfavourable subsets Unfavourable subsets
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Metastatic disease primarily to the liver or to multiple other sites. Metastatic disease primarily to the liver or to multiple other sites.
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Malignant ascites of unknown origin with non-papillary serous adenocarcinoma histology Malignant ascites of unknown origin with non-papillary serous adenocarcinoma histology
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Metastatic CUP to the lungs either as parenchymal metastases or isolated malignant pleural effusion Metastatic CUP to the lungs either as parenchymal metastases or isolated malignant pleural effusion
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Patients with multiple brain metastases Patients with multiple brain metastases
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Patients with multiple metastatic bone lesions Patients with multiple metastatic bone lesions
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Natural history and further management Natural history and further management
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Favourable subsets Favourable subsets
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Women with adenocarcinoma involving only axillary nodes Women with adenocarcinoma involving only axillary nodes
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Women with papillary adenocarcinoma of peritoneal cavity Women with papillary adenocarcinoma of peritoneal cavity
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Poorly differentiated carcinoma with midline distribution Poorly differentiated carcinoma with midline distribution
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Squamous cell carcinoma involving cervical or supraclavicular lymph nodes Squamous cell carcinoma involving cervical or supraclavicular lymph nodes
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Poorly differentiated neuroendocrine carcinomas Poorly differentiated neuroendocrine carcinomas
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Men with osteoblastic bone metastases and elevated PSA with adenocarcinoma histology Men with osteoblastic bone metastases and elevated PSA with adenocarcinoma histology
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Isolated inguinal lymphadenopathy from squamous cell carcinoma Isolated inguinal lymphadenopathy from squamous cell carcinoma
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Unfavourable subsets Unfavourable subsets
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References References
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Cite
Extract
Cancer of unknown primary site
Introduction
Cancer of unknown primary (CUP) site is one of the 10 most frequent cancers, accounting for approximately 3–5% of all malignant tumours. Patients with CUP present with disseminated metastatic lesions for which a laboratory and clinical work-up fail to identify the primary site.
CUP represents a heterogeneous group of mainly epithelial tumours with more or less unique clinical and biological behaviour.
Definition
The definition of CUP includes patients who present with histologically confirmed metastatic cancer in whom a detailed medical history, complete physical examination, full blood count, biochemistry, urinalysis and stool occult blood testing, histopathological review of biopsy with the use of immunohistochemistry, chest radiography, CT of the abdomen and pelvis, and in certain cases mammography or FDG-PET scan, fail to detect the primary tumour.
Pathology
CUP consists of several clinicopathological subsets of favourable or unfavourable prognosis.
Histologically, 80% of CUP patients are diagnosed with an adenocarcinoma type, 50% of which are well to moderately differentiated and 30% poorly differentiated or undifferentiated adenocarcinomas. Squamous cell histology accounts for 15% of the cases and of the rest 5% are undifferentiated neoplasms such as not specified carcinomas, neuroendocrine tumours, lymphomas, germ cells tumours, melanomas, sarcomas, or embryonal malignancies.
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