When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Adenocarcinoma of unknown primary site

  • Visão geral
  • Teoria
  • Diagnóstico
  • Tratamento
  • ACOMPANHAMENTO
  • Recursos
Última revisão: 13 Oct 2025
Última atualização: 30 Jul 2025

Resumo

განსაზღვრება

ანამნეზი და გასინჯვა

ძირითადი დიაგნოსტიკური ფაქტორები

  • pain (e.g., abdomen, chest, bone)
  • family history of cancer
  • constitutional symptoms
სრული ტექსტი

სხვა დიაგნოსტიკური ფაქტორები

  • jaundice
  • symptoms of postobstructive pneumonia
  • hemoptysis
  • ascites
  • cervical chain adenopathy
  • personal history of previous cancer
  • history of smoking
  • palpable mass
  • neuropathic pain or weakness
  • headaches
  • seizures
  • delirium
  • history of heavy alcohol consumption
  • hepatomegaly
სრული ტექსტი

რისკფაქტორები

  • age >60 years
სრული ტექსტი

დიაგნოსტიკური კვლევები

1-ად შესაკვეთი გამოკვლევები

  • complete blood count
  • comprehensive metabolic panel
  • CT chest/abdomen/pelvis
  • MRI
  • biopsy (pathologic assessment)
  • immunohistochemistry (IHC) tests
სრული ტექსტი

გასათვალისწინებელი კვლევები

  • fecal occult blood test
  • lactate dehydrogenase
  • urinalysis
  • 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET)/CT
  • breast imaging (mammography, MRI, ultrasound)
  • transvaginal ultrasound
  • paracentesis
  • endoscopy
  • direct laryngoscopy with or without esophagoscopy and bronchoscopy
  • serum tumor markers
  • genetic biomarker testing
სრული ტექსტი

ახალი ტესტები

  • tissue of origin testing

მკურნალობის ალგორითმი

საწყისი

identification of primary site pending

მწვავე

unfavorable subtype: multiple metastases and/or without a likely primary site

favorable subtype: women with isolated axillary lymphadenopathy (likely breast primary)

favorable subtype: women with peritoneal carcinomatosis of a serous papillary adenocarcinoma (likely ovarian primary)

favorable subtype: poorly differentiated carcinoma with neuroendocrine features (likely small cell lung cancer primary)

favorable subtype: well-differentiated neuroendocrine tumors (likely neuroendocrine primary)

favorable subtype: adenocarcinoma with colorectal immunohistochemistry (likely colorectal primary)

favorable subtype: poorly differentiated carcinoma of the mediastinum or retroperitoneum in males <40 years (likely testicular primary)

favorable subtype: blastic bone metastases with immunohistochemistry/serum prostate-specific antigen (likely prostate primary)

favorable subtype: single metastatic lesion

favorable subtype: oligometastatic disease

კონტრიბუტორები

ავტორები

Michael S. Lee, MD

Associate Professor

Department of Gastrointestinal Medical Oncology

Division of Cancer Medicine

University of Texas MD Anderson Cancer Center

Houston

TX

გაფრთხილება:

MSL has consulted for Pfizer, Bayer, Delcath, and Imvax. His institution has received research funding from Amgen, Exelixis, Bristol-Myers Squibb, Pfizer, Rafael Pharmaceuticals, EMD Serono, Genentech/Roche, Merck, Arcus, and Shanghai EpiMab Biotherapeutics. MSL is the author of a number of papers cited in this topic.

მადლიერება

Dr Michael S. Lee would like to gratefully acknowledge Dr Ross C. Donehower, Dr David Cosgrove, and Dr Hatim Hussain, previous contributors to this topic.

Declarações

RCD, DC, and HH declare that they have no competing interests.

Revisores

Nikhil Khushalani, MD

Assistant Professor

Department of Medicine

Roswell Park Cancer Institute

Buffalo

NY

Declarações

NK declares that he has no competing interests.

Zelig Tochner, MD

Associate Professor

Radiation Oncology

Children's Hospital of Philadelphia

Philadelphia

PA

Declarações

ZT declares that he has no competing interests.

Justin Stebbing, MA, MRCP, MRCPath, PhD

Consultant Medical Oncologist/Senior Lecturer

Department of Medical Oncology

Imperial College/Imperial Healthcare NHS Trust

Charing Cross Hospital

London

UK

Disclosures

JS declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: occult primary [internet publication].Full text

Krämer A, Bochtler T, Pauli C, et al. Cancer of unknown primary: ESMO clinical practice guideline for diagnosis, treatment and follow-up. Ann Oncol. 2023 Mar;34(3):228-46.Full text  Abstract

National Institute for Health and Care Excellence. Metastatic malignant disease of unknown primary origin in adults: diagnosis and management. Apr 2023 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Adenocarcinoma of unknown primary site images

  • Differentials

    • Squamous or neuroendocrine carcinoma of unknown primary
    More Differentials

  • Guidelines

    • NCCN clinical practice guidelines in oncology: head and neck cancers
    • NCCN clinical practice guidelines in oncology: occult primary
    More Guidelines
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer