Adenocarcinoma of unknown primary site
Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- pain (e.g., abdomen, chest, bone)
- family history of cancer
- constitutional symptoms
Outros fatores diagnósticos
- jaundice
- symptoms of post-obstructive pneumonia
- haemoptysis
- 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
Fatores de risco
- age >60 years
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- full blood count
- comprehensive metabolic panel
- CT chest/abdomen/pelvis
- MRI
- biopsy (pathological assessment)
- immunohistochemistry (IHC) tests
Investigações a serem consideradas
- 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 oesophagoscopy and bronchoscopy
- serum tumour markers
- genetic biomarker testing
Novos exames
- tissue of origin testing
Algoritmo de tratamento
identification of primary site pending
unfavourable subtype: multiple metastases and/or without a likely primary site
favourable subtype: women with isolated axillary lymphadenopathy (likely breast primary)
favourable subtype: women with peritoneal carcinomatosis of a serous papillary adenocarcinoma (likely ovarian primary)
favourable subtype: poorly differentiated carcinoma with neuroendocrine features (likely small cell lung cancer primary)
favourable subtype: well-differentiated neuroendocrine tumours (likely neuroendocrine primary)
favourable subtype: adenocarcinoma with colorectal immunohistochemistry (likely colorectal primary)
favourable subtype: poorly differentiated carcinoma of the mediastinum or retroperitoneum in males <40 years (likely testicular primary)
favourable subtype: blastic bone metastases with immunohistochemistry/serum prostate-specific antigen (likely prostate primary)
favourable subtype: single metastatic lesion
favourable subtype: oligometastatic disease
Colaboradores
Autores
Michael S. Lee, MD
Associate Professor
Department of Gastrointestinal Medical Oncology
Division of Cancer Medicine
University of Texas MD Anderson Cancer Center
Houston
TX
Declarações
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.
Agradecimentos
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
Disclosures
NK declares that he has no competing interests.
Zelig Tochner, MD
Associate Professor
Radiation Oncology
Children's Hospital of Philadelphia
Philadelphia
PA
Disclosures
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
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.
Differentials
- Squamous or neuroendocrine carcinoma of unknown primary
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: head and neck cancers
- NCCN clinical practice guidelines in oncology: occult primary
More Guidelines
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