Nationwide Survey on Family-perceived Experiences of Patients With Cancer of Unknown Primary Site

Purpose: Cancer of unknown primary site (CUP) is an aggressive disease with poor prognosis. As research on the experiences of CUP patients and their families is scarce, this study aimed to compare the family-perceived burden of CUP with that of common cancers (lung, colon, and stomach cancer). Additional aims were to explore the association between family-perceived burden and CUP patients’ quality of life (QOL) at end-of-life and family depression.Methods: This was a pre-planned secondary analysis of nationwide cross-sectional survey data from the bereaved family members of patients with cancer who died at 286 institutions. The major measurements were the eight-item family-perceived Burden scale (comprising specialist access, uncertainty, and prolonged diagnosis), Good Death Inventory, and Patient Health Questionnaire 9.Results: Of the total 27,591 survey responses, we analyzed 97 and 717 responses from the family members of patients with CUP and common cancer, respectively. The families of CUP patients scored significantly higher on all three burden subscales than those of common cancer patients (effect sizes: specialist access subscale, 0.3; uncertainty subscale, 0.66; and prolonged diagnosis subscale, 0.69; adjusted P < 0.01). Greater family Burden was significantly associated with lower patient QOL and higher family depression. Burden was significantly associated with being a spouse, second opinion consultation, and diagnosis period of >1 month.Conclusion: The families of CUP patients experience poor specialist access, greater uncertainty, and a prolonged diagnosis. They should be cared for from the initial stages to establish access to specialists, obtain an early diagnosis, and reduce uncertainty.

The usefulness of [18F]FDG-PET/CT in detecting and managing cancers with unknown primary site depends on histological subtype

We assessed the role of [18F]FDG-PET/CT in identifying and managing cancer of unknown primary site (CUP syndrome). We reviewed [18F]FDG-PET/CT scans of individuals with CUP syndrome recorded in clinical referral letters from 2012 to 2019. We evaluated the identification of primary tumor (PT) by [18F]FDG-PET/CT, according to histological subtype, and the impact on clinical management. The median age was 65 years, 36/64 males (56%). PTs were detected in 28/64 (44%) patients. Detection was significantly lower in patients with squamous cell carcinoma (SCC) than with other histologies combined, p = 0.034. Mean age, mean SUVmax (10.6 ± 6.0) and organ involvement were similar between patients with and without discovered PTs; and between patients with SCC and with other histologies combined. However, those with SCC were less likely than the others to present with multi-lesion involvement, p < 0.001. [18F]FDG-PET/CT interpretations apparently affected treatment of 8/28 (29%) patients with PT detected, and in none of the 35 whose PT was not discovered, p < 0.001. [18F]FDG-PET/CT appeared helpful in detecting PT in almost half the patients with CUP syndrome; the lowest rate was for patients with SCC pathology. PET/CT showed limited overall value in guiding clinical management, however benefited those with discovered PT.

Inguinal Lymph Node Squamous Cell Carcinoma of Unknown Primary Site

Resumen El carcinoma escamoso de piel y mucosas presenta un riesgo potencial de metástasis ganglionares, con la posibilidad de que este suceso preceda la presentación clínica del tumor primario. El objetivo del presente trabajo es describir un caso de linfadenectomía inguinal por metástasis de carcinoma escamoso de origen primario desconocido y realizar una revisión bibliográfica de los casos presentados en la literatura médica. Se describió el caso de un hombre de 84 años con una tumoración inguinal correspondiente a una neoplasia escamosa, se le realizó una evaluación multidisciplinaria con dermatología, urología y coloproctología, sin encontrar el tumor primario. Se efectuó un vaciamiento inguinal con radioterapia postoperatoria. En la base de datos de Medline informaron solo 49 casos en los últimos 10 años. Las metástasis inguinales de carcinomas escamosos representan un grupo heterogéneo de neoplasias que pueden originarse a partir de la región anogenital o de territorios cutáneos de la zona perineal, miembros inferiores o parte baja del tronco. El manejo diagnóstico y terapéutico de estas lesiones continúa siendo un desafío al que se debe enfrentar con todas las herramientas disponibles y de forma multidisciplinaria.