Carcinoma of an Unknown Primary Site

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ISBN: 9780824727994 | 0824727991
Cover: Hardcover
Copyright: 4/18/2006

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Institute Gustave Roussy, Villejuif, France. Provides recommendations and research on carcinoma of an unkonwn primary site (CUP). Topics include diagnostic evaluation in carcinomas, advent of immunohistochemistry in CUP, the importance of identifying CUP subsets, and more. For oncologists oncologists. DNLM: Neoplasms, Unknown Primary-diagnosis-Case reports.

Preface	p. iii
Contributors	p. xiii
Carcinomas of Unknown Primary Site: Several Things We Know for Sure
What We Know About Carcinomas of Unknown Primary Site (CUP) Almost for Sure: Incidence, Survival, and Necropsy Data	p. 1
Introduction	p. 2
Incidence and Mortality	p. 2
Clinical Behavior of CUP	p. 5
Autopsy Data	p. 6
Survival	p. 7
References	p. 8
Diagnostic Evaluation in Carcinomas of Unknown Primary Site: What Shall We Do and When Shall We Stop Seeking the Primary Site?
Radiographic Studies, Endoscopy, and Serum Tumor Markers in the Diagnostic Evaluation of Carcinomas of Unknown Primary Site	p. 11
Introduction	p. 11
Chest X Ray	p. 13
Computed Axial Tomography	p. 14
Contrast Studies of the GI Tract and Endoscopic Procedures	p. 16
Serum Tumor Markers	p. 18
Survival Patterns and Their Effect on Diagnostic Strategies in Patients Presenting with Occult Primary Cancer	p. 19
Conclusion and Future Directions	p. 21
References	p. 22
The Advent of Immunohistochemistry in Carcinoma of Unknown Primary Site: A Major Progress	p. 25
Introduction	p. 25
Methods	p. 26
Strategies for Specific Histopathological Types	p. 30
Strategies Depending on Anatomic Localization	p. 32
Targeted Treatment of CUP	p. 32
Conclusion	p. 33
References	p. 33
The Importance of Identifying CUP Subsets	p. 37
Introduction	p. 37
Histopathological Subtypes	p. 38
Clinicopathological Entities	p. 39
Favorable Subsets	p. 40
Unfavorable Subsets	p. 43
References	p. 45
Emerging Diagnostic Tools
Role of Positron Emission Tomography with 18F-Fluorodesoxyglucose (PET-FDG) in the Care of Carcinomas of an Unknown Primary Site	p. 49
Introduction	p. 49
PET-FDG and Cervical Metastases of Unknown Primary	p. 51
PET-FDG and CUP Not Targeted on Cervical Metastases	p. 55
Conclusions	p. 57
References	p. 58
Prognostic Factors
Prognostic Considerations in Patients with Unknown Primary Carcinoma	p. 61
Introduction	p. 61
Prognostic Factors in UPC Patients with PDC and PDA	p. 63
Prognostic Factors in the General Population of UPC Patients	p. 68
Prognostic Factors and UPC Clinical Trials	p. 73
Conclusion	p. 74
References	p. 75
Systemic Chemotherapy
Treatment of Patients with Favorable Subsets of Unknown Primary Carcinoma	p. 79
Introduction	p. 79
Women with Peritoneal Carcinomatosis	p. 79
Women with Axillary Lymph Node Metastases	p. 81
Adenocarcinoma Presenting as a Single Metastatic Lesion	p. 81
Young Men with Features of Extragonadal Germ Cell Tumor	p. 82
Squamous Carcinoma Involving Cervical Lymph Nodes	p. 82
Squamous Carcinoma Involving Inguinal Lymph Nodes	p. 83
Neuroendocrine Carcinoma with an Unknown Primary Site	p. 84
Poorly Differentiated Carcinoma	p. 86
Conclusion	p. 88
References	p. 88
Chemotherapy for Patients with Metastatic Carcinoma of Unknown Primary Site	p. 93
Introduction	p. 93
Historical Background	p. 94
The Minnie Pearl Cancer Research Network Experience	p. 95
The French Experience	p. 95
At the End, Does Chemotherapy Improve Survival?	p. 98
Conclusion	p. 101
References	p. 101
Randomized Trials in Patients with Carcinoma of an Unknown Primary Site: The Past, the Present, and the Future	p. 105
Introduction	p. 105
Methods	p. 106
Results	p. 110
References	p. 114
Local Treatments in Carcinoma of Unknown Primary Site: Is It Relevant?
Squamous Cell Carcinoma of an Unknown Primary Tumor Located in the Cervical Lymph Nodes	p. 117
Summary	p. 117
Introduction	p. 118
Epidemiology	p. 118
Patient Work-Up	p. 118
The Role of PET	p. 119
Staging	p. 120
Prognosis	p. 120
Treatment	p. 121
Follow-Up	p. 122
References	p. 123
Women with Isolated Adenocarcinoma in the Axillary Lymph Node of an Unknown Primary Site	p. 127
Introduction	p. 127
Incidence	p. 128
Presentation	p. 128
Para-Clinical Examinations	p. 128
Treatment	p. 129
Prognosis	p. 130
Conclusion	p. 130
References	p. 130
Carcinoma of Unknown Primary in a Single Site	p. 133
Introduction	p. 133
Differential Diagnosis and Paraclinic Investigations	p. 134
Localized Lymph-Node Metastases of a CUP	p. 135
Liver Metastasis from a CUP in a Single Site	p. 137
Isolated Bone Metastasis	p. 138
Solitary Pulmonary Nodule from a CUP	p. 139
Localized Pleural Effusion of a CUP	p. 140
Single Cerebral Metastasis of a CUP	p. 141
Metastasis of Cutaneous or Soft Tissues from a CUP	p. 143
Conclusion	p. 143
References	p. 143
Emerging Local Treatments in Carcinomas of an Unknown Primary Site: Radiofrequency, Palliative Bone Surgery, and Radiotherapy	p. 147
Introduction	p. 147
Radiofrequency	p. 148
Palliative Bone Surgery	p. 149
Radiotherapy	p. 153
References	p. 155
The Biology of Carcinoma of Unknown Primary Site
The Biology of Unknown Primary Tumors: The Little We Know, the Importance of Learning More	p. 159
Introduction	p. 159
Nosological Considerations	p. 160
Research Aims and Instruments	p. 161
Brief Summary of Current Knowledge on the Metastatic Phenotype	p. 163
Specific and Nonspecific Biological Features of UPTs	p. 164
What Is the p53 Status in UPTs?	p. 165
Acquisition of the Metastatic Phenotype in UPTs: From Speculation to Testable Hypotheses	p. 166
The Enigma of Primary Tumor Growth Inhibition	p. 167
Search for Prognostic Biological Indicators and Assessment of Potential Molecular Targets	p. 169
Conclusion	p. 171
References	p. 171
Quality of Life and Psychosocial Aspects
Psychosocial Aspects of Cancer of Unknown Primary Site	p. 175
Introduction	p. 175
Psychosocial Adjustment and Cancer	p. 177
Assessment and Prevalence of Psychosocial Distress in Patients with Known Primary Cancers and in Patients with CUP	p. 178
Aspects of Psychosocial Adjustment in CUP Patients: Illness Uncertainty, Depression, Anxiety, and Perception of Physician's Supportive Behavior	p. 179
QOL Instruments in CUP	p. 181
Diagnosis, Prognosis, and Treatment Plan: Preliminary Findings in CUP Patients	p. 182
Challenging Physician-Patient Communication Tasks in CUP	p. 183
Conclusion	p. 189
References	p. 190
Clinical Cases of Carcinoma of Unknown Primary Site
A Female Patient with Pleural Extension of an Unknown Primary Carcinoma	p. 195
Comment	p. 196
A Favorable Case of CUP with Peritoneal Adenocarcinomatosis	p. 199
Comment	p. 200
Clear Cell Adenocarcinoma Presenting as a Carcinoma of Unknown Primary Origin	p. 201
A Female Patient with a Single-Site Carcinoma of an Unknown Primary Located on the Thoracic Wall	p. 208
Comment	p. 209
An Unfavorable Case of CUP with Metastatic Adenocarcinoma to the Liver and Bones
Comment	p. 212
A Favorable Case of CUP with Metastatic Adenocarcinoma of the Liver with Neuroendocrine Differentiation	p. 214
Comment	p. 215
Carcinoma or Melanoma of an Unknown Primary?	p. 216
Comment	p. 217
A Male Patient with HIV Infection and Carcinoma of an Unknown Primary Site	p. 218
Comment	p. 220
A 66-Year-Old Male with Liver Metastases of an Unknown Primary Site	p. 223
Comment	p. 224
An Undifferentiated Carcinoma of an Unknown Primary of the Middle Line in a Young Adult	p. 221
Comment	p. 229
A Female with Bone Metastases of an Unknown Primary Site	p. 231
Comment	p. 233
Index	p. 237
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Carcinoma of an Unknown Primary Site

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