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Adenocarcinoma de sítio primário desconhecido

  • Visão geral
  • Teoria
  • Diagnóstico
  • Tratamento
  • ACOMPANHAMENTO
  • Recursos
Last reviewed: 13 Sep 2025
Last updated: 30 Jul 2025

Summary

Definition

History and exam

Key diagnostic factors

  • dor (por exemplo, abdome, tórax, osso)
  • história familiar de câncer
  • sintomas constitucionais
Full details

Other diagnostic factors

  • 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
Full details

Risk factors

  • idade >60 anos
Full details

Diagnostic investigations

1st investigations to order

  • hemograma completo
  • perfil metabólico completo
  • TC do tórax/abdome/pelve
  • RNM
  • biópsia (avaliação patológica)
  • exames de coloração imuno-histoquímica
Full details

Investigations to consider

  • 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
Full details

Emerging tests

  • teste de tecido de origem

Treatment algorithm

INITIAL

identificação do sítio primário pendente

ACUTE

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

Contributors

Authors

Michael S. Lee, MD

Associate Professor

Department of Gastrointestinal Medical Oncology

Division of Cancer Medicine

University of Texas MD Anderson Cancer Center

Houston

TX

Disclosures

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.

Acknowledgements

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

Divulgaciones

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 de sítio primário desconhecido images

  • Differentials

    • Carcinoma de células escamosas ou neuroendócrinos de sítio primário desconhecido
    More Differentials

  • Guidelines

    • NCCN clinical practice guidelines in oncology: head and neck cancers
    • NCCN clinical practice guidelines in oncology: occult primary
    More Guidelines
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