scholarly journals The Diminishing Importance of Primary Site Identification in Cancer of Unknown Primary: A Canadian Single-Center Experience

2021 ◽  
Vol 11 ◽  
Author(s):  
Boaz Wong ◽  
Michael M. Vickers ◽  
Paul Wheatley-Price
Keyword(s):  
Primary Tumor ◽  
Treatment Guidelines ◽  
Descriptive Analysis ◽  
Cancer Of Unknown Primary ◽  
Primary Site ◽  
Unknown Primary ◽  
Primary Tumor Site ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Site Identification

BackgroundCancer of unknown primary (CUP) describes patients with metastatic disease without an identified primary tumor site. Successful diagnosis and treatment of these patients remains difficult. Published guidelines on CUP have highlighted “favorable” subtype groups. We investigated a series of CUP patients to review adherence to guidelines, and identification of primary cancers or “favorable” subtypes.MethodsPatients with histologically confirmed CUP at an academic institution from 2012 to 2018 were identified. Patient demographics, tumor presentation, diagnostic work-up and treatment information were retrospectively collected from electronic data records for descriptive analysis and compared to published clinical guidelines. The primary endpoint was the proportion of patients where the primary site was identified. Multivariable logistic regression models were used to identify factors associated with primary site identification. Kaplan-Meier survival curves were used to determine factors associated with poorer OS.ResultsThree hundred and five patients were included with a median follow-up time of 4.3 months. Primary tumor sites were identified in 109 patients (37.5%), which was most commonly lung cancer (33%). Statistical analyses did not identify any demographic or initial presentation factors associated with identifying the primary or not. More diagnostic tests did not increase the likelihood of primary site identification (P=0.44). Patients with an identified primary did not have longer OS than other patients (median 5.2 months vs. 4.7 months, P=0.47). 57 patients (18.7%) who had a defined “favorable” subtype experienced superior OS (36.6 months vs. 3.8 months; P<0.0001). Further, patients with good prognostic status who followed published treatment guidelines had longer OS (17.6 months vs. 13.2 months; P=0.04).ConclusionsCUP remains a difficult cancer to diagnose and treat. These results suggest identifying the primary has less impact than anticipated, but particular efforts to identify patients with “favorable” subtypes of CUP is important prognostically.

Can Computed Tomography Characteristics of the Oropharynx in Cancer of Unknown Primary Predict Primary Tumor Site?

2014 ◽  
Vol 151 (1_suppl) ◽  
pp. P157-P158
Author(s):  
Ryan P. McSpadden ◽  
Thomas P. Sullivan ◽  
Jordan Rosenblum ◽  
Carol M. Bier-laning
Keyword(s):  
Computed Tomography ◽  
Primary Tumor ◽  
Cancer Of Unknown Primary ◽  
Unknown Primary ◽  
Tumor Site ◽  
Primary Tumor Site

The role of whole body 18F-FDG PET/CT scan in patients with carcinoma of unknown primary

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e22051-e22051
Author(s):  
M. Hu ◽  
J. Yu ◽  
N. Liu ◽  
L. Kong ◽  
P. Zhang
Keyword(s):  
Ct Scan ◽  
Primary Tumor ◽  
Fdg Pet ◽  
Primary Site ◽  
Unknown Primary ◽  
Tumor Site ◽  
Primary Tumor Site ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Pet Ct Scan

e22051 Background: Carcinoma of unknown primary (CUP) is a heterogeneous group of tumors and usually follows an aggressive biological and clinical behavior. Difficult challenges in oncology which the identification of the primary tumor and a complete disease staging could offer a more rational and efficient treatment in order to improve the survival time. Our aim was to evaluate the role of 18F-FDG PET/CT scan with two aspects: detection of the primary site, and estimation of tumor biological behavior which essential for the development of new, individual and targeted effective therapies. Methods: One hundred and seventeen patients presenting with histologically confirmed metastatic carcinoma (76 lymph nodes, 41 visceral biopsy proven) of unknown primary site were included in this retrospective study. The evaluations as follows had not revealed a primary site: detailed medical history, full physical and laboratory examinations, and diagnostic imaging methods. All patients underwent PET/CT. Results: In 42 (35.90%) patients, a primary tumor site which was confirmed by follow-up or surgery was showed by PET/CT. In 15 (12.82%) patients, the primary tumor site was suggested by PET/CT but not confirmed. In 60 (51.28%) patients, the primary tumor site was not localized modifying the stage of disease. In the other 17 (14.53%) patients, PET/CT scan identified further unexpected metastases. Overall, the following oncological treatment was influenced by the PET/CT scan, in a total of 38 (32.47%) patients. Between the adenocarcinoma and squamous cell carcinoma groups, no significant difference in SUVmax was found ( t=1.191, p = 0.244). A significantly higher SUVmax was found among patients with poorly or undifferentiated carcinoma compared with patients with well to moderately ( t=4.013, p<0.01) differentiation; In 42 patients with a confirmed primary tumor site, the SUVmax of Metastatic tumours have a closely relationship correlate with those of primary tumours, ( r=0.738, p<0.01). Furthermore, a significantly higher SUVmax was found among metastases compared with primary tumors ( t=3.470, p<0.01). Conclusions: Our data strongly support 18F-FDG PET/ CT imagings not only provide new insights in the diagnosis and staging of patients with CUP, but also evaluate biologic characters of tissue. 1 No significant financial relationships to disclose.

How to Diagnose and Treat a Cancer of Unknown Primary Site

2017 ◽  
Vol 26 (1) ◽  
Author(s):  
Ciprian Tomuleasa ◽  
Florin Zaharie ◽  
Mihai Stefan Muresan ◽  
Mihai Stefan Muresan ◽  
Laura Pop
Keyword(s):  
Clinical Diagnosis ◽  
Randomized Clinical Trials ◽  
Empirical Therapy ◽  
Standard Of Care ◽  
Cancer Of Unknown Primary ◽  
Primary Site ◽  
Unknown Primary ◽  
Unknown Primary Site ◽  
Primary Tumor Site ◽  
Primary Origin

Almost one in every three patients with advanced tumors have distant metastasis at the time of clinical diagnosis. In most cases, the primary tumor site is identified immediately, within a few days. But for some patients, the primary lesion cannot be found after the initial clinical assessment. These cases are called cancers of unknown primary origin (CUPs), a clinical diagnosis very difficult to manage by physicians due to the absence of a standard-of-care for the initial therapeutic regimen, as well as due to the impossibility to include these cases in randomized clinical trials. A cancer of unknown primary site is often associated with a poor prognosis as patients are usually treated with a non-selective empirical therapy. In the current paper, we summarize both the diagnostic challenges for patients with a cancer of unknown primary site as well as the current available therapeutic options, with emphasis on the management of this unique disease entity.

ctDNA analysis in patients with cancer of unknown primary and its value in guiding targeted treatment when combined with predicted cancer types by 90-gene reverse-transcription polymerase chain reaction assay.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18730-e18730
Author(s):  
Xin Liu ◽  
Shiyu Jiang ◽  
Xiaowei Zhang ◽  
Xiaoyan Zhou ◽  
Zhiguo Luo ◽  
...  
Keyword(s):  
Genetic Alterations ◽  
Cancer Of Unknown Primary ◽  
Primary Site ◽  
Targeted Treatment ◽  
Unknown Primary ◽  
Chain Reaction ◽  
Cdkn2a Mutation ◽  
Cancer Types ◽  
Polymerase Chain ◽  
Level 1

e18730 Background: No targeted agents except for drugs against NTRK fusion, dMMR/MSI-H or TMB-H are recommended for the treatment of cancer of unknown primary (CUP), despite of the occurrence of multiple actionable mutations identified by NGS. We aimed to explore the characteristics of circulating tumor DNA (ctDNA) and its value in guiding targeted treatment in combination with predicted cancer types by 90-gene reverse-transcription polymerase chain reaction assay for tissue origin. Methods: 172 treatment-naïve CUP patients with ctDNA testing were retrospectively included between April 2017 and Oct 2020. Of them, 98 patients had primary site predicted. Genetic alterations were reclassified based on their predicted primary site and the oncoKB scale. 153 patients treated with the first-line therapy and available survival data were used to explore prognostic value of detected genetic alterations in ctDNA. Results: We identified 82.6% (142/172) of patients had alterations detected, with the most commonly seen mutations of TP53 (51%), ARID1A (11%), KRAS (10%), RB1 (9%), APC (8%), PI3KCA (8%) and NFE2L2 (7%). The most commonly observed actionable mutations were PIK3CA (n=14, 9.8%), ERBB2 (n=7, 4.9%), BRAF (n=6, 4.2%), MET (n=6, 4.2%) and EGFR (n=5, 3.5%). After introducing predicted primary site in the 98 patients, 6.1% (n=6) of patients upgraded to a Level 1 alteration, 1.0% (n=1) to a Level 2 alteration (Table). In these 7 patients, only one patient with predicted lung cancer and EGFR 19 del received gefitinib with partial response for 5+ months. In multivariate analysis, NFE2L2 (hazard ratio [HR] = 2.96, 95%CI=1.32-6.61, P = .008) and CDKN2A mutation (HR = 2.50, 95%CI=1.26-4.96, P = .009) were independently associated with shorter PFS. Furthermore, NFE2L2 (HR = 4.96, 95%CI=1.98-12.43, P ＜ .001) and CDKN2A mutation (HR = 4.84, 95%CI=1.63-14.40, P = .005) were correlated with worse OS. Conclusions: This is the first attempt to integrate ctDNA sequencing and gene expression profiling for tissue of origin in OncoKB classification schema, resulting in 7.1% (7/98) of the genetic alterations reclassified to level 1 or 2, which might identify patients benefiting from corresponding targeted treatment. NFE2L2 and CDKN2A mutations in ctDNA were associated poor prognosis.[Table: see text]

scholarly journals Dermatomyositis Associated with Cancer of Unknown Primary Site

2007 ◽  
Vol 22 (Suppl) ◽  
pp. S174 ◽  
Author(s):  
Hyung Il Kim ◽  
Sung Hoon Chung ◽  
Jun Eul Hwang ◽  
Sang Ho Kim ◽  
Jae Sook Ahn ◽  
...  
Keyword(s):  
Cancer Of Unknown Primary ◽  
Primary Site ◽  
Unknown Primary ◽  
Unknown Primary Site

scholarly journals Cancer of Unknown Primary Site Mimicking Retroperitoneal Fibrosis

2018 ◽  
Vol 93 (6) ◽  
pp. 575-581
Author(s):  
Chan Keol Park ◽  
Su-Jin Yoo ◽  
In Seol Yoo ◽  
Jinhyun Kim ◽  
Seung Cheol Shim ◽  
...  
Keyword(s):  
Retroperitoneal Fibrosis ◽  
Cancer Of Unknown Primary ◽  
Primary Site ◽  
Unknown Primary ◽  
Unknown Primary Site

scholarly journals Resection Of A Retroperitoneal Cancer Of Unknown Primary Site After Chemoradiation Therapy: A Case Report

2020 ◽  
Author(s):  
Tomonari Suetsugu ◽  
Nobuhisa Matsuhashi ◽  
Hiroshi Tsuchiya ◽  
Takao Takahashi ◽  
Masahiro Fukada ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Iliac Artery ◽  
Cancer Of Unknown Primary ◽  
Primary Site ◽  
Unknown Primary ◽  
Unknown Primary Site ◽  
Multidisciplinary Therapy ◽  
Carcinoma Of Unknown Primary

Abstract Background: Complete recovery from retroperitoneal squamous cell carcinoma of unknown primary site treated by multidisciplinary therapy is extremely rare.Case presentation: A 78-year-old man was referred to our hospital due to a mass measuring 8 cm in size in the left pelvic retroperitoneal area, which was diagnosed as a cancer of unknown primary site. The pathological type was squamous cell carcinoma. The left iliac artery/vein and ureter were involved in the tumor, and the tumor caused severe left leg pain. Although inflammation and symptoms were severe, palliative radiotherapy was considered. After that, biweekly combined therapy with docetaxel, cisplatin, and fluorouracil was planned. After 5 courses of chemotherapy, the tumor diameter reduced from 11.6 cm to 4 cm in size. In addition, the border between the iliac vessels, urinary tract and tumor became apparent. The patient underwent radical resection of the tumor 8 months after the treatment started. The left ureter and the external/internal iliac artery were preserved, but the external iliac vein was sacrificed because of the possibility of tumor invasion. The postoperative course was free of complications, and the patient was discharged 10 days after the operation. The histopathological findings showed no residual viable tumor cells or foreign body-type giant cells with necrosis. The pathological effect of chemotherapy was defined as Grade 3 (pathological complete response). The patient has experienced no recurrence or distant metastasis for 4 years.Conclusions: Multidisciplinary therapy succeeded in treating a retroperitoneal squamous cell carcinoma of unknown primary site with preservation of organ function.

Cancer of Unknown Primary Site

Oncology ◽  
2007 ◽  
pp. 1119-1132 ◽  
Author(s):  
F. Anthony Greco ◽  
John D. Hainsworth
Keyword(s):  
Cancer Of Unknown Primary ◽  
Primary Site ◽  
Unknown Primary ◽  
Unknown Primary Site

Cancer of unknown primary (CUP)

2007 ◽  
pp. 357-360
Keyword(s):  
Metastatic Potential ◽  
Cancer Of Unknown Primary ◽  
Postmortem Examination ◽  
Primary Site ◽  
Unknown Primary ◽  
Nursing Management

Introduction and prognosis 358 Treatment and nursing management 359 • Common oncological problem representing up to 15% of all referrals. • The primary site of a carcinoma remains undetected even after postmortem examination in around 20–25% of these cases. • Normally arises due to the unusual metastatic potential of the tumour but occasionally there has been regression of the primary (well recognized in melanoma)....

Sign in / Sign up

Export Citation Format

Share Document