View source for Cancer of unknown primary origin diagnostic study of choice

__NOTOC__
{{Cancer of unknown primary origin}}
{{CMG}} {{shyam}}; {{AE}}; {{RAK}}
== Overview ==
The diagnosis of cancer of unknown primary origin is made when the following [[diagnostic criteria]] are met: [[Biopsy|tissue biopsy]] indicating [[malignancy]] and all known primary origins of [[cancer]] are ruled out.

== Diagnostic Study of Choice ==
*The diagnosis of cancer of unknown primary origin is made when the following [[diagnostic criteria]] are met: [[Biopsy|tissue biopsy]] indicating [[malignancy]] and all known primary origins of [[cancer]] are ruled out.
*The search of the primary tumor's [[anatomical]] location has proven to be very challenging and costly; nevertheless, it is pursued with focus on the types of [[tumors]] that might benefit from efficient and targeted [[Therapy|treatment]].<ref name="pmid3046543">{{cite journal| author=Le Chevalier T, Cvitkovic E, Caille P, Harvey J, Contesso G, Spielmann M et al.| title=Early metastatic cancer of unknown primary origin at presentation. A clinical study of 302 consecutive autopsied patients. | journal=Arch Intern Med | year= 1988 | volume= 148 | issue= 9 | pages= 2035-9 | pmid=3046543 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3046543  }} </ref><ref name="pmid10388044">{{cite journal| author=Briasoulis E, Pavlidis N| title=Cancer of Unknown Primary Origin. | journal=Oncologist | year= 1997 | volume= 2 | issue= 3 | pages= 142-152 | pmid=10388044 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10388044  }} </ref>
*The initial approach may vary on a case-by-case basis; however, the diagnosis is made after [[histopathological]] and [[Clinical examination|clinical testing]]:<ref name="pmid25392080">{{cite journal| author=Collado Martín R, García Palomo A, de la Cruz Merino L, Borrega García P, Barón Duarte FJ, Spanish Society for Medical Oncology| title=Clinical guideline SEOM: cancer of unknown primary site. | journal=Clin Transl Oncol | year= 2014 | volume= 16 | issue= 12 | pages= 1091-7 | pmid=25392080 | doi=10.1007/s12094-014-1244-0 | pmc=4239766 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25392080  }} </ref>
**The [[histopathological]] examination of the tissue includes [[Microscopic examination|microscopic evaluation]] followed by [[Immunohistochemistry|immunohistochemical analysis]].
**Clinical diagnostic tests must be exhausted in order to aid in identifying the primary origin and this includes:<ref name="pmid12915904">{{cite journal |vauthors=Bugat R, Bataillard A, Lesimple T, Voigt JJ, Culine S, Lortholary A, Merrouche Y, Ganem G, Kaminsky MC, Negrier S, Perol M, Laforêt C, Bedossa P, Bertrand G, Coindre JM, Fizazi K |title=Summary of the Standards, Options and Recommendations for the management of patients with carcinoma of unknown primary site (2002) |journal=Br. J. Cancer |volume=89 Suppl 1 |issue= |pages=S59–66 |year=2003 |pmid=12915904 |pmc=2753014 |doi=10.1038/sj.bjc.6601085 |url=}}</ref>
**#Detailed [[medical history]] and full [[physical exam]]
**#[[Complete blood counts|Complete blood count]]
**#[[Liver function test|Liver function tests]]
**#[[Electrolyte|Electrolytes]]
**#[[Urinalysis]]
**#[[Fecal occult blood test|Fecal occult blood]]
**#[[Chest radiography]]
**#[[Chest]], [[Abdomen|abdominal]], and [[Pelvis|pelvic]] [[CT scan]] (depending on the case)
=== Study of choice ===
There is no single diagnostic study of choice for the diagnosis of cancer of unknown primary. 


* The [[Algorithms|algorithm]] below explains the specific situations where certain diagnostic studies are recommended:<ref name="pmid26314775">{{cite journal| author=Fizazi K, Greco FA, Pavlidis N, Daugaard G, Oien K, Pentheroudakis G et al.| title=Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. | journal=Ann Oncol | year= 2015 | volume= 26 Suppl 5 | issue= | pages= v133-8 | pmid=26314775 | doi=10.1093/annonc/mdv305 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26314775 }} </ref><ref name="pmid12915904">{{cite journal| author=Bugat R, Bataillard A, Lesimple T, Voigt JJ, Culine S, Lortholary A et al.| title=Summary of the Standards, Options and Recommendations for the management of patients with carcinoma of unknown primary site (2002). | journal=Br J Cancer | year= 2003 | volume= 89 Suppl 1 | issue=  | pages= S59-66 | pmid=12915904 | doi=10.1038/sj.bjc.6601085 | pmc=2753014 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12915904  }} </ref>


{{familytree/start |summary= Algorithm for diagnosis of cancer of unknown primary origin}}
{{familytree | | | | | | | | | | | A01 | | | | | | | | |A01='''Tumor of unknown primary origin'''}}
{{familytree | | | | | | | | | | | |!| | | | | | | | | |}}
{{familytree | | | | | | | | | | |boxstyle=text-align: left; | B01 | | | | | | |B01= • Full medical history and physical exam<br> • Basic blood and biochemical analysis<br> • CT scan of chest, abdomen, and pelvis}}
{{familytree | | | | | | | | | | | |!| | | | | | | | | }}
{{familytree | | | | | | | | | | | C01 | | | | | | |C01=Histopathologic examination}}
{{familytree | | | | | |,|-|-|-|-|-|+|-|-|-|-|-|.| | | }}
{{familytree | | | | |D01| | | | D02| | | | D03 |D01='''Squamous cell carcinoma'''|D02='''Neuroendocrine carcinoma'''|D03='''Adenocarcinoma and poorly differntiated carcinoma'''}}
{{familytree | | | | | |!| | | | | |!| | | | | |!| | | | }}
{{familytree | | | | | |!| | | | |boxstyle=text-align: left;|E01| | | | |!| |E01=• Octreoscan<br>• Plasma chromogranin A}}
{{familytree | | | | |F01| | | | | | | | | | F02 | |F01=Additional tests specific to location of metastasis|F02=Additional tests speciifc to gender}}
{{familytree | | | | | |!| | | | | | | | | | | |!|| | }}
{{familytree | | |,|-|-|+|-|-|-|.| | | | | |,|-|^|-|.| | | }}
{{familytree | G01 | | G02 | | G03 | | | | G04 | | G05 | | | |G01=Cervical lymphadenopathy|G02=Inguinal lymphadenopathy|G03=Bone metastasis|G04=Men|G05=Women}}
{{familytree | |!| | | |!| | | |!| | | | | |!| | | |!| | | | | }}
{{familytree |boxstyle=text-align: left;| H01 | | H02 | | H03 | | | | H04 | | H05 | | | |H01=• Panendoscopy<br>• CT scan of head and neck<br>• Diagnostic bilateral tonsillectomy|H02=• Complete clinical examination of external genital organs<br>• Pelvic CT scan or ultrasound|H03=• Anoscopy<br>• Colposcopy (if female)<br>• Complete clinical examination of head and neck<br>• Panendoscopy<br>• Bone scintigraphy<br>• Xrays of painful areas|H04=• PSA<br>• αFP<br>• βHCG|H05=• Mammography<br>• Pelvic ultrasound or CT scan}}
{{familytree | | | | | | | | | | | | | | | |!| | | |!| | | | |}}
{{familytree | | | | | | | | | | | | | | | |`|-|v|-|'| | | | |}}
{{familytree | | | | | | | | | | | | | | | | | I01 | | | | | | |I01=Additional tests specific to location of metastasis}}
{{familytree | |,|-|-|-|v|-|-|-|v|-|-|-|v|-|-|-|+|-|-|-|v|-|-|-|v|-|-|-|v|-|-|-|.|}}
{{familytree | J01 | | J02 | | J03 | | J04 | | J05 | | J06 | | J07 | | J08 | | J09 |J01=Midline and/or mediastinal lymphadenopathy|J02=Cervical and/or supraclavicular lymphadenopathy|J03=Axillary lymphadenopathy|J04=Liver metastasis|J05=Lung metastasis|J06=Bone metastasis|J07=Single metastasis|J08=Pleural effusion|J09=Peritoneal effusion}}
{{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| |}}
{{familytree |boxstyle=text-align: left;| K01 | | K02 | | K03 | | K04 | | K05 | | K06 | | K07 | | K08 | | K09 |K01=• Testicular ultrasound<br>• Chest and abdominal CT scan|K02=• Testicular ultrasound<br>• Head and neck CT scan<br>• Panendoscopy<br>• EBV testing (to rule out undifferentiated nasopharyngeal carcinoma)|K03='''Women:'''<br>• Breast ultrasound<br>• Breast MRI|K04='''Women:'''<br>• αFP assay (if undifferntiated carcinoma)<br>• Colposcopy|K05='''Women:'''<br>• βHCG<br>'''Men:'''<br>• Testicular ultrasound<br>• Chest and abdominal CT scan|K06=• Bone scintigraphy<br>• Xrays of painful areas|K07=• Full body CT scan<br>• Bone scintigraphy|K08=• Chest CT scan|K09='''Women:'''<br>• Abdominal and pelvic CT scan}}
{{familytree/end}}

===Molecular studies===
There is no data to support routine molecular testing for assessment of cancer of unknown primary. In the past, molecular testing was routinely done in an effort to identify the cell or origin.

=== Diagnostic criteria ===

There is no single diagnostic study of choice for cancer of unknown primary.

==References==
{{Reflist|2}}
{{WH}}
{{WS}}