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Adenocarcinoma de sítio primário desconhecido

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  • 概述
  • 理论
  • 诊断
  • 治疗
  • 随访
  • 资源
最后审阅： 1 Dec 2025
最后更新： 30 Jul 2025

小结

定义

病史和体格检查

关键诊断因素

  • dor (por exemplo, abdome, tórax, osso)
  • história familiar de câncer
  • sintomas constitucionais
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其他诊断因素

  • icterícia
  • sintomas de pneumonia pós-obstrutiva
  • hemoptise
  • ascite
  • adenopatia da cadeia cervical
  • história pessoal de câncer prévio
  • história de tabagismo
  • massa palpável
  • dor ou fraqueza neuropática
  • cefaleias
  • convulsões
  • delirium
  • história de consumo excessivo de bebidas alcoólicas
  • hepatomegalia
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危险因素

  • idade >60 anos
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诊断性检查

首要检查

  • hemograma completo
  • perfil metabólico completo
  • TC do tórax/abdome/pelve
  • RNM
  • biópsia (avaliação patológica)
  • exames de coloração imuno-histoquímica
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需考虑的检查

  • exame de sangue oculto nas fezes
  • lactato desidrogenase
  • urinálise
  • tomografia por emissão de pósitrons com 18F-fluordesoxiglucose/TC (FDG-PET-TC)
  • imagem da mama (mamografia, RNM, ultrassonografia)
  • ultrassonografia transvaginal
  • paracentese
  • endoscopia
  • laringoscopia direta, com ou sem esofagoscopia e broncoscopia
  • marcadores tumorais séricos
  • testes de biomarcadores genéticos
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新兴检查

  • teste de tecido de origem

治疗流程

初步治疗

identificação do sítio primário pendente

急症处理

subtipo desfavorável: metástases múltiplas e/ou sem provável sítio primário

subtipo favorável: mulheres com linfadenopatia axilar isolada (provavelmente primária da mama)

subtipo favorável: mulheres com carcinomatose peritoneal de um adenocarcinoma papilar seroso (provavelmente de sítio primário ovariano)

subtipo favorável: carcinoma pouco diferenciado com características neuroendócrinas (provavelmente câncer pulmonar de células pequenas primário)

subtipo favorável: tumores neuroendócrinos bem diferenciados (provavelmente sítio primário neuroendócrino)

subtipo favorável: adenocarcinoma com imuno-histoquímica colorretal (provavelmente sítio primário colorretal)

subtipo favorável: carcinoma pouco diferenciado do mediastino ou retroperitônio em homens <40 anos (provavelmente sítio primário testicular)

subtipo favorável: metástases ósseas blásticas com imuno-histoquímica/antígeno prostático específico sérico (provavelmente próstata como sítio primário)

subtipo favorável: lesão metastática única

subtipo favorável: doença oligometastática

撰稿人

作者

Michael S. Lee, MD

Associate Professor

Department of Gastrointestinal Medical Oncology

Division of Cancer Medicine

University of Texas MD Anderson Cancer Center

Houston

TX

利益声明

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.

鸣谢

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.

Disclosures

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

Peer reviewers

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

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.

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