386:
312:
because the primary tumor is not identified due to clinical or technological inefficiencies, or because the primary tumor regresses or stays dormant after spreading the cancer cells that generate the metastases. This view is widely accepted in oncology; in fact, these cancers are also referred to as occult primary tumors. Because the site of the primary tumor usually dictates the treatment and expected outcome, this view may help create uncertainty and anxiety among health professionals and patients, who may feel that their evaluation has been incomplete.
316:
site before or without generating a tumor in their original tissue. Forming a tumor in a tissue is not a prerequisite for stem cells to move away from that tissue. Stem cells can migrate from their natural tissue and initiate a cancer in the new site before generating a detectable tumor in their natural tissue. In this case, the primary tumor could be identified after some time. However, stem cells can also migrate away from their natural tissue without generating a cancer there. In this case, the "primary tumor" would never exist (see
471:
281:
2074:
2104:
2114:
22:
320:). This can explain why the primary site is not identified even on postmortem examination in many patients with these cancers. This view of CUP may provide relief to health professionals and patients. After a detailed imaging and pathologic analysis, oncologists can tell their patients with CUP that metastasis does not always involve the formation of a primary tumor, and that their diagnostic evaluation is complete.
398:
site is important because knowing its location and type often helps doctors plan the best treatment. Treatment that is specific to the suspected type of cancer is likely to be more effective. Still, when diagnostic tests have not identified the primary site, doctors must decide whether the potential benefits of more extensive testing outweigh a patient's discomfort, possible complications, and the financial costs.
2094:
114:
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may be used alone or in combination to treat patients who have CUP. Even when the cancer is unlikely to be cured, treatment may help the patient live longer or improve the patient's quality of life. Radiation may be used to shrink a variety of local tumors. However, the potential side effects of the
413:
sometimes helps to identify the source of the cancer. Individual tests often do not provide definitive answers, but sometimes patterns may be observed, suggesting a particular site of origin (e.g. lung, colon, etc.). Immunohistochemical testing suggests a single source of cancer origin in about one
558:
Most people with cancer of unknown primary origin have widely disseminated and incurable disease, although a few can be cured through treatment. With treatment, typical survival with CUP ranges from 6 to 16 months. Survival rates are lower in cases with visceral metastatic disease, ranging from 6
315:
Because stem cells have a natural ability to migrate and also play a key role in cancer development, it has been proposed that a cancer of unknown primary site may form when deregulated, premalignant or cancerous stem cells migrate away from their natural tissue and give rise to a cancer in the new
311:
Cancer of unknown primary source is not a single type of cancer, although researchers have attempted to find a common characteristic that explains why a cancer might spread very early without causing symptoms at the site of origin. It is generally accepted that cancer of unknown primary site exists
397:
Sometimes, however, even when doctors use very sophisticated methods to try to identify the primary site, the part of the body the cancer cells came from cannot be determined. About 2 to 4 percent of all cancer patients have a cancer whose primary site is never found. Identifying the primary tumor
505:
If the site of origin is unknown or undiscovered, then the histology of the tumor (e.g., adenocarcinoma, squamous cell or mesenchymal) can usually be identified, and a probable origin may be assumed. When this is possible, then treatment is based on the type of cell and probable origin. Based on
583:
From 1980 to 1990, definition of unknown primary cancer was based on imaging results. Subsequently, research on immunohistochemistry allowed for the classification of cancer of unknown primary into sub-types. From 2000 to 2010, tailored therapies began to evolve, targeting specific subtypes of
328:
In recent years, microscopic and other diagnostic techniques have improved dramatically. However, the tissue of origin can be still determined only about in one in four cases of CUPs with these methods. In some cases, the part of the body where cancer cells are first discovered helps the doctor
502:
involvement, treatment is offered along the lines of breast cancer. In patients, who have neck lymph node involvement, then treatment is offered along the lines of head and neck cancer. If inguinal lymph nodes are involved, then treatment may be offered along the lines of genitourinary cancer.
501:
Because CUP refers to many different cancers, treatment depends on where the cancer is found, the microscopic appearance of the cancer cells, the biochemical characterization of the cells, and the patient's age and overall physical condition. In women, who present with axillary lymph node
220:
performed for another indication. The disease typically develops rapidly, and metastases may occur in places in the body that are otherwise unusual. Comprehensive physical examination is part of the process to identify a possible primary source of cancer; this should include the
559:
to 9 months. Survival rates are higher when the cancer is more limited to lymph nodes, pleura, or peritoneal metastasis, which ranges from 14 to 16 months. Long-term prognosis is somewhat better if a particular source of cancer is strongly suggested by clinical evidence.
382:. Germ cell tumors usually begin in the ovaries and testes. In patients in whom the primary cancer is eventually found, the lung and pancreas are the most common primary cancer sites. CUP also may be traced to the breast, prostate, colon, or rectum as the primary site.
201:. Less commonly, a metastatic tumor is found first; but in most such cases, the primary tumor can then be located via examination and testing. Rarely (3–5% of the time), the primary tumor cannot be found because it is too small, or because it has
438:
refers to cancer that begins in the cells in glandular structures in the lining or covering of certain organs in the body. Common primary sites for adenocarcinomas include the lung, pancreas, breast, prostate, stomach, liver, and colon.
329:
decide which diagnostic tests will be most helpful. Additional clues which may be helpful in determining the primary site include the pattern of spread, and the cell type, which is based on its appearance under a microscope (
546:
treatment must be considered along with the potential benefits. In CUP to secondary neck nodes, surgery followed by external beam radiotherapy is sufficient. For CUP with an unfavorable prognosis, treatment with
371:, at sites such as the lung and breast. If the metastatic cancer appears first in the lower part of the body, the primary cancer is more likely to be at sites below the diaphragm, such as the pancreas and liver.
1234:
1219:
414:
in four cases of CUP. However, there is a lack of definitive research data showing that treatment guided by information from immunohistochemical testing improves outcomes or long-term prognosis.
567:
CUP sometimes runs in families. It has been associated with familial lung, kidney, and colorectal cancers, which suggests that these sites may often be the origin of unidentifiable CUP cancers.
409:
may be used to determine the expression of protein markers on the surface of cancer cells. Often the expression of these antigens is similar to the tissue that the cancer grew from, so
374:
When the cancer cells are poorly differentiated (that is, they look less evolved than normal cells when viewed under a microscope), the cancer may be either a lymphoma or a
197:. Over the course of time—particularly if the primary tumor is left untreated—smaller "satellite" tumors will appear at other places in the body, a phenomenon known as
519:
367:
The pattern of spread may suggest the location of the primary site. For example, metastatic cancer found in the upper body is more likely to have an origin above the
364:
should be done for squamous cell carcinoma involving lymph nodes of the neck region. For other types of cancer of unknown primary, a PET-CT offers uncertain benefit.
770:
244:
The location of metastases may be a clue as to the underlying source, even if this cannot be found on investigations. For instance, a woman in whom there is
1120:"Evaluation of survival benefits by platinums and taxanes for an unfavourable subset of carcinoma of unknown primary: a systematic review and meta-analysis"
32:
185:
in most (80 to 85%) of those circumstances. The other 15 to 20% of patients, however, have a relatively long survival with appropriate treatment.
550:
may provide a slight survival benefit. The uncertainties and ambiguity inherent in a CUP diagnosis may cause additional stress for the patient.
93:
575:
Around 9,800 people were diagnosed with cancer of unknown primary in the UK in 2011, and around 10,625 people died from the disease in 2012.
65:
961:
72:
1603:
1944:
637:
79:
1543:
61:
1843:
1175:
985:
844:"The migration ability of stem cells can explain the existence of cancer of unknown primary site. Rethinking metastasis"
174:
cannot be identified. A diagnosis of CUP requires a clinical picture consistent with metastatic disease and one or more
1979:
1321:
515:
482:
393:
tumor cells which are undifferentiated, that is, the primary tumor cannot be determined by their histologic appearance.
292:
1118:
Lee, J.; Hahn, S.; Kim, D.-W.; Kim, J.; Kang, S. N.; Rha, S. Y.; Lee, K. B.; Kang, J.-H.; Park, B.-J. (Jan 15, 2013).
51:
2097:
1969:
1403:
86:
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activity or other factors. In such situations a diagnosis of cancer of unknown primary origin (CUP) is made.
1949:
47:
1593:
789:
1573:
431:
1069:"Survival in carcinoma of unknown primary to neck nodes treated with neck dissection and radiotherapy"
2002:
930:
212:
CUP usually comes to attention because of masses or swellings found somewhere in the body, either by
40:
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36:
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Histopathology of a biopsy of a lymph node with cancer of unknown primary origin, showing high-
202:
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CUP is found in about 3 to 5% of all people diagnosed with invasive cancer, and carries a poor
2017:
1903:
1876:
1849:
1801:
1755:
1450:
916:
Varadhachary, Gauri R.; Raber, Martin N. (21 August 2014). "Cancer of
Unknown Primary Site".
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261:
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The remaining 10 percent are either poorly or undifferentiated malignant neoplasms (5%), or
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1997:
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1678:
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1653:
1588:
1440:
674:"Cancers of unknown primary origin: current perspectives and future therapeutic strategies"
447:
345:
249:
213:
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Ettinger, David S.; Agulnik, Mark; Cates, Justin M. M.; Cristea, Mihaela (December 2011).
8:
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1418:
1238:
638:"Rarer cancers with unknown primary tumours diagnosed too late – Press releases – GOV.UK"
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2007:
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of the chest, abdomen, and pelvis, with IV contrast. Women with enlarged lymph nodes (
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to evaluate for possible breast cancer. If those imaging studies are normal, then an
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adenocarcinoma, while about 30% are poorly differentiated adenocarcinoma. The term
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histological subtype, combination chemotherapy may be selected. A combination of
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Clinical guideline 104: Metastatic malignant disease of unknown primary origin
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Pavlidis N, Pentheroudakis G (April 2012). "Cancer of unknown primary site".
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Stella, GM; Senetta, R; Cassenti, A; Ronco, M; Cassoni, P (24 January 2012).
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790:"Cancer of Unknown Primary Origin | Memorial Sloan Kettering Cancer Center"
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526:, which if identified, directs treatment for metastatic germ cell tumors.
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if you can. Unsourced or poorly sourced material may be challenged and
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may also be employed. Germ cell tumors often carry abnormality of
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1223:
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222:
175:
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1066:
426:. The majority of cancers of unknown primary, about 90%, are
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The initial work-up of a cancer of unknown primary includes a
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1299:
1017:
671:
1291:– UK-based information and support for patients with CUP.
1280:
Clinically reviewed information on unknown primary cancer
357:
1067:
Krishnatreya M, Sharma JD, Kataki AC, Kalita M (2014).
727:
771:
National
Institute for Health and Clinical Excellence
1201:
1024:
Journal of the
National Comprehensive Cancer Network
814:"Carcinoma of Unknown Primary—Patient Version - NCI"
915:
837:
835:
833:
2130:
529:No method is standard for all forms of CUP, but
422:CUP may be classified by its appearance under a
911:
909:
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1073:Annals of Medical and Health Sciences Research
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46:Please review the contents of the article and
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514:is often used. Advances techniques such as
430:, with 60% appearing as moderately to well-
193:Most cancers typically present as a single
1604:Reproductive endocrinology and infertility
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1308:
256:, and men with lymph node deposits in the
1945:Bachelor of Medicine, Bachelor of Surgery
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178:results inconsistent with a tumor cancer
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665:
384:
962:"Tests for a Cancer of Unknown Primary"
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2131:
1176:"Cancer of unknown primary statistics"
170:stage at the time of diagnosis, but a
1303:
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1007:
1005:
662:
596:"Carcinoma of Unknown Primary Origin"
360:of the breast may be appropriate. A
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1844:Physical medicine and rehabilitation
465:
454:, such as sarcomatoid, basaloid, or
275:
15:
2093:
233:, external genitals, as well as an
13:
1980:Medical Scientist Training Program
1295:Cancer.Net: Unknown Primary Cancer
1002:
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235:internal examination of the rectum
62:"Cancer of unknown primary origin"
14:
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1289:The CUP Foundation – Jo's Friends
1197:
678:Journal of Translational Medicine
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2102:
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2073:
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600:Gastrointestinal Cancer Research
469:
446:(5%). Rarely, CUP may appear as
279:
166:that is determined to be at the
156:Cancer of unknown primary origin
129:Cancer of unknown primary origin
112:
20:
2113:
1168:
1111:
1060:
918:New England Journal of Medicine
594:Varadhachary, Gauri R. (2007).
562:
254:cancer originated in the breast
1970:Doctor of Osteopathic Medicine
1404:Oral and maxillofacial surgery
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954:
806:
782:
48:add the appropriate references
1:
742:10.1016/S0140-6736(11)61178-1
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461:
1950:Bachelor of Medical Sciences
1717:Neurosurgical anesthesiology
1329:
553:
323:
271:
7:
986:"Cancer of unknown primary"
842:López-Lázaro (1 May 2015).
411:immunohistochemical testing
402:Immunohistochemical testing
33:reliable medical references
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264:of the abdomen may have a
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1990:
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1124:British Journal of Cancer
378:. Lymphomas begin in the
250:lymph nodes of the armpit
141:
133:
128:
39:or relies too heavily on
1904:Transplantation medicine
1795:Clinical neurophysiology
1712:Obstetric anesthesiology
1632:Interventional radiology
1392:Digestive system surgery
1086:10.4103/2141-9248.138050
860:10.18632/oncoscience.159
520:tissue of origin testing
456:adenosquamous carcinomas
444:squamous cell carcinomas
252:) it is likely that the
246:axillary lymphadenopathy
1775:Intensive care medicine
1749:Mass gathering medicine
1594:Maternal–fetal medicine
1037:10.6004/jnccn.2011.0117
691:10.1186/1479-5876-10-12
348:with CUP should have a
1367:Cardiothoracic surgery
394:
2018:Personalized medicine
1877:Reproductive medicine
1802:Occupational medicine
1756:Evolutionary medicine
940:10.1056/NEJMra1303917
570:
448:neuroendocrine tumors
388:
262:retroperitoneal space
2038:Traditional medicine
1998:Alternative medicine
1865:Addiction psychiatry
1679:Transfusion medicine
1674:Medical microbiology
1589:Gynecologic oncology
1441:Reproductive surgery
1136:10.1038/bjc.2012.516
1079:(Suppl 2): S165–S6.
990:www.macmillan.org.uk
260:of the chest and/or
239:of the pelvic organs
214:physical examination
2060:History of medicine
2043:Veterinary medicine
1850:Preventive medicine
1702:Adolescent medicine
1544:Infectious diseases
1282:for patients, from
2008:Molecular oncology
1965:Doctor of Medicine
1955:Master of Medicine
1872:Radiation oncology
1744:Emergency medicine
1697:Addiction medicine
1664:Clinical chemistry
1659:Clinical pathology
1451:Transplant surgery
1409:Orthopedic surgery
1387:Colorectal surgery
1284:Cancer Research UK
1180:Cancer Research UK
481:. You can help by
395:
344:) confined to the
291:. You can help by
189:Signs and symptoms
2126:
2125:
1960:Master of Surgery
1924:
1923:
1909:Tropical medicine
1855:Prison healthcare
1770:Hospital medicine
1734:Disaster medicine
1724:Aviation medicine
1539:Hospital medicine
1446:Surgical oncology
1431:Pediatric surgery
1425:
1372:Endocrine surgery
1264:
1263:
1030:(12): 1358–1395.
736:(9824): 1428–35.
584:unknown primary.
535:radiation therapy
499:
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309:
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248:(swelling in the
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123:Medical condition
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1020:"Occult primary"
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2139:Types of cancer
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2053:Chief physician
1986:
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1920:
1914:Travel medicine
1899:Sports medicine
1882:Sexual medicine
1822:Palliative care
1817:Pain management
1761:Family medicine
1739:Diving medicine
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1613:
1575:
1568:
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1436:Plastic surgery
1382:General surgery
1362:Cardiac surgery
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779:. London, 2010.
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588:Further reading
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539:hormone therapy
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479:needs expansion
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428:adenocarcinomas
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376:germ cell tumor
346:axillary region
342:lymphadenopathy
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289:needs expansion
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266:germ cell tumor
218:medical imaging
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924:(8): 757–765.
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477:This section
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207:immune system
204:
200:
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195:primary tumor
186:
184:
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172:primary tumor
169:
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149:
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137:Occult cancer
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110:
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95:
92:
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71:
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64: –
63:
59:
58:Find sources:
53:
49:
43:
42:
38:
34:
29:This article
27:
18:
17:
2028:Rural health
2013:Nanomedicine
1564:Rheumatology
1495: /
1414:Hand surgery
1399:Neurosurgery
1268:
1248:
1233:
1218:
1183:. Retrieved
1179:
1170:
1130:(1): 39–48.
1127:
1123:
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1023:
993:. Retrieved
989:
980:
969:. Retrieved
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847:
821:. Retrieved
817:
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645:. Retrieved
641:
603:
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566:
563:Epidemiology
557:
531:chemotherapy
528:
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500:
487:
483:adding to it
478:
452:mixed tumors
441:
435:
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37:verification
30:
2098:Wikiproject
1887:Venereology
1832:Neonatology
1729:Dermatology
1584:Gynaecology
1576:gynaecology
1559:Pulmonology
1377:Eye surgery
1339:Specialties
848:Oncoscience
508:carboplatin
490:August 2014
362:PET CT scan
300:August 2014
258:mediastinum
227:lymph nodes
134:Other names
31:needs more
1860:Psychiatry
1846:(PM&R)
1839:Phlebology
1827:Pediatrics
1654:Anatomical
1619:Diagnostic
1599:Obstetrics
1549:Nephrology
1534:Hematology
1529:Geriatrics
1522:Hepatology
1507:Cardiology
1497:Immunology
1185:27 October
995:2024-09-07
971:2024-09-07
823:2024-09-07
799:2024-09-07
656:References
647:2015-07-06
642:www.gov.uk
512:paclitaxel
462:Management
407:Antibodies
354:ultrasound
199:metastasis
168:metastatic
73:newspapers
2048:Physician
1932:education
1790:Neurology
1785:Narcology
1649:Pathology
1627:Radiology
1502:Angiology
1466:Andrology
1275:eMedicine
1144:1532-1827
1046:1540-1413
926:CiteSeerX
612:1934-7820
554:Prognosis
369:diaphragm
350:mammogram
331:histology
324:Diagnosis
272:Mechanism
203:regressed
183:prognosis
143:Specialty
103:July 2015
2133:Category
2078:Category
1554:Oncology
1485:medicine
1483:Internal
1331:Medicine
1270:med/1463
1162:23175147
1105:25184090
1054:22157556
948:25140961
878:26097879
758:44385281
750:22414598
710:22272606
630:19262901
148:Oncology
2118:Outline
2088:Commons
2033:Therapy
1930:Medical
1493:Allergy
1461:Urology
1354:Surgery
1255:D009382
1153:3553519
1096:4145520
869:4468332
701:3315427
621:2631214
579:History
548:taxanes
543:surgery
338:CT scan
223:breasts
205:due to
162:) is a
87:scholar
52:removed
2108:Portal
1975:MD–PhD
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164:cancer
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1244:199.1
1229:C80.0
754:S2CID
450:, or
391:grade
94:JSTOR
80:books
1250:MeSH
1239:9-CM
1187:2014
1158:PMID
1140:ISSN
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516:FISH
510:and
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