Cancer of unknown primary origin: Difference between revisions

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Revision as of 15:25, 1 April 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Synonyms and keywords: Occult cancer; CUP; Metastases of unknown primary origin; Unknown primary origin neoplasm; cancers of unknown primary site; neoplasms of unknown primary site

Overview

'Cancer of unknown primary origin is the diagnosis when metastatic cancer is found but the place where the cancer began (the primary site) cannot be determined. About 2 to 4 percent of all cancer patients have a cancer whose primary site is never identified. Treatment for CUP depends on many factors, including where the metastatic cancer is found, what the cancer cells look like under a microscope, and the patient’s age and general health.

Historical Perspective

Cancer of unknown primary origin was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
In [year], [gene] mutations were first identified in the pathogenesis of cancer of unknown primary origin.
In [year], the first [discovery] was developed by [scientist] to treat/diagnose cancer of unknown primary origin.

Classification

Cancer of unknown primary origin may be classified according to [classification method] into [number] subtypes/groups:

[group1]
[group2]
[group3]

Other variants of cancer of unknown primary origin include [disease subtype 1], [disease subtype 2], and [disease subtype 3].

Pathophysiology

The pathogenesis of Cancer of unknown primary origin is characterized by [feature1], [feature2], and [feature3].
The [gene name] gene/Mutation in [gene name] has been associated with the development of cancer of unknown primary origin, involving the [molecular pathway] pathway.
On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of Cancer of unknown primary origin.
On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of Cancer of unknown primary origin.

Causes

Cancer of unknown primary origin may be caused by either [cause1], [cause2], or [cause3].
Cancer of unknown primary origin is caused by a mutation in the [gene1], [gene2], or [gene3] gene[s].
There are no established causes for cancer of unknown primary origin.

Differentiating Cancer of Unknown Primary Origin from Other Diseases

Cancer of unknown primary origin must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:

[Differential dx1]
[Differential dx2]
[Differential dx3]

Epidemiology and Demographics

The prevalence of cancer of unknown primary origin is approximately [number or range] per 100,000 individuals worldwide.
In [year], the incidence of Cancer of unknown primary origin was estimated to be [number or range] cases per 100,000 individuals in [location].

Age

Patients of all age groups may develop cancer of unknown primary origin.

Cancer of unknown primary origin is more commonly observed among patients aged [age range] years old.
Cancer of unknown primary origin is more commonly observed among [elderly patients/young patients/children].

Gender

Cancer of unknown primary origin affects men and women equally.

[Gender 1] are more commonly affected with cancer of unknown primary origin than [gender 2].
The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.

Race

There is no racial predilection for cancer of unknown primary origin.

Cancer of unknown primary origin usually affects individuals of the [race 1] race.
[Race 2] individuals are less likely to develop Cancer of unknown primary origin.

Risk Factors

Common risk factors in the development of cancer of unknown primary origin are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

Natural History, Complications and Prognosis

The majority of patients with cancer of unknown primary origin remain asymptomatic for [duration/years].
Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
If left untreated, [#%] of patients with Cancer of unknown primary origin may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
Common complications of Cancer of unknown primary origin include [complication 1], [complication 2], and [complication 3].
Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with Cancer of unknown primary origin is approximately [#%].

Diagnosis

Diagnostic Criteria

The diagnosis of cancer of unknown primary origin is made when at least [number] of the following [number] diagnostic criteria are met:

[criterion 1]
[criterion 2]
[criterion 3]
[criterion 4]

Symptoms

Cancer of unknown primary origin is usually asymptomatic.
Symptoms of cancer of unknown primary origin may include the following:

[symptom 1]
[symptom 2]
[symptom 3]
[symptom 4]
[symptom 5]
[symptom 6]

Physical Examination

Patients with cancer of unknown primary origin usually appear [general appearance].
Physical examination may be remarkable for:

[finding 1]
[finding 2]
[finding 3]
[finding 4]
[finding 5]
[finding 6]

Laboratory Findings

There are no specific laboratory findings associated with cancer of unknown primary origin.

A [positive/negative] [test name] is diagnostic of cancer of unknown primary origin.
An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of Cancer of unknown primary origin.
Other laboratory findings consistent with the diagnosis of Cancer of unknown primary origin include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

Imaging Findings

There are no [imaging study] findings associated with cancer of unknown primary origin.

[Imaging study 1] is the imaging modality of choice for cancer of unknown primary origin.
On [imaging study 1], Cancer of unknown primary origin is characterized by [finding 1], [finding 2], and [finding 3].
[Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

Cancer of unknown primary origin may also be diagnosed using [diagnostic study name].
Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

There is no treatment for cancer of unknown primary origin; the mainstay of therapy is supportive care.

The mainstay of therapy for cancer of unknown primary origin is [medical therapy 1] and [medical therapy 2].
[Medical therapy 1] acts by [mechanism of action1].
Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].

Surgery

Surgery is the mainstay of therapy for cancer of unknown primary origin.
[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of Cancer of unknown primary origin.
[Surgical procedure] can only be performed for patients with [disease stage] Cancer of unknown primary origin.

Prevention

There are no primary preventive measures available for cancer of unknown primary origin.

Effective measures for the primary prevention of cancer of unknown primary origin include [measure1], [measure2], and [measure3].

Once diagnosed and successfully treated, patients with Cancer of unknown primary origin are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].

References

@@ Line 1: / Line 1: @@
-{{Infobox_Disease |
+__NOTOC__
-  Name           = {{PAGENAME}} |
+{{SI}}
-  Image          = |
+{{CMG}} {{AE}} {{MV}}
-  Caption        = |
-  DiseasesDB     = |
+{{SK}} Occult cancer; CUP; Metastases of unknown primary origin; Unknown primary origin neoplasm; cancers of unknown primary site; neoplasms of unknown primary site
-  ICD10          = |
-  ICD9           = |
-  ICDO           = |
-  OMIM           = |
-  MedlinePlus    = |
-  eMedicineSubj  = |
-  eMedicineTopic = |
-  MeshID         = |
-}}
-{{SI}}
-{{CMG}}
 ==Overview==
-'''Cancer of unknown primary (CUP) origin''' is the diagnosis when metastatic cancer is found but the place where the cancer began (the primary site) cannot be determined. About 2 to 4 percent of all cancer patients have a cancer whose primary site is never identified.
+''''Cancer of unknown primary origin'''  is the diagnosis when metastatic cancer is found but the place where the cancer began (the primary site) cannot be determined. About 2 to 4 percent of all cancer patients have a cancer whose primary site is never identified. Treatment for CUP depends on many factors, including where the metastatic cancer is found, what the cancer cells look like under a microscope, and the patient’s age and general health.
-Treatment for CUP depends on many factors, including where the metastatic cancer is found, what the cancer cells look like under a microscope, and the patient’s age and general health.
-Cancer can begin in any organ or tissue of the body. The primary, or original, tumor is usually named for the part of the body or the type of tissue in which the cancer begins. The disease can spread (metastasize) from the primary tumor and form metastatic tumors in other parts of the body. For example, breast cancer cells can metastasize to the lungs and cause the growth of a new tumor. When this happens, the tumor in the lung is called metastatic breast cancer because it is composed of breast cancer cells, not lung cancer cells.
-Each year in the United States, several thousand people are diagnosed with metastatic cancer whose primary cancer site is not known. When the primary site cannot be identified, this disease may be called carcinoma of unknown primary (CUP). Most often, the metastatic cancer is first found in the lymph nodes, liver, lung, or bone.
-In recent years, microscopic and other diagnostic techniques have improved dramatically. For this reason, doctors can now determine the primary site in about four out of five cases first diagnosed as CUP. In some cases, the part of the body where cancer cells are first found helps the doctor decide which diagnostic tests will be most helpful. Doctors also have other clues that help them find the primary site:
-* The pattern of spread may suggest the location of the primary site. When the metastatic cancer is found in the upper part of the body, the original site is likely to be above the diaphragm (the thin muscle under the lungs that separates the chest from the abdomen) at sites such as the lung and breast. If the metastatic cancer appears first in the lower part of the body, the primary cancer is likely to be at sites below the diaphragm, such as the pancreas and liver.
-* The type of cell found in the metastatic cancer can also provide clues about the hidden primary site.
-Most patients with an unidentified primary tumor have a cell type called adenocarcinoma. The term adenocarcinoma refers to cancer that begins in the cells in glandular structures in the lining or covering of certain organs in the body. Common primary sites for adenocarcinomas include the lung, pancreas, breast, prostate, stomach, liver, and colon.
+==Historical Perspective==
+*Cancer of unknown primary origin was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
+*In [year], [gene] mutations were first identified in the pathogenesis of cancer of unknown primary origin.
+*In [year], the first [discovery] was developed by [scientist] to treat/diagnose cancer of unknown primary origin.
+==Classification==
+*Cancer of unknown primary origin may be classified according to [classification method] into [number] subtypes/groups:
+:*[group1]
+:*[group2]
+:*[group3]
+*Other variants of cancer of unknown primary origin include [disease subtype 1], [disease subtype 2], and [disease subtype 3].
+==Pathophysiology==
+*The pathogenesis of Cancer of unknown primary origin is characterized by [feature1], [feature2], and [feature3].
+*The [gene name] gene/Mutation in [gene name] has been associated with the development of cancer of unknown primary origin, involving the [molecular pathway] pathway.
+*On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of Cancer of unknown primary origin.
+*On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of Cancer of unknown primary origin.
+==Causes==
+* Cancer of unknown primary origin may be caused by either [cause1], [cause2], or [cause3].
+* Cancer of unknown primary origin is caused by a mutation in the [gene1], [gene2], or [gene3] gene[s].
+* There are no established causes for cancer of unknown primary origin.
+==Differentiating Cancer of Unknown Primary Origin from Other Diseases==
+*Cancer of unknown primary origin must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
+:*[Differential dx1]
+:*[Differential dx2]
+:*[Differential dx3]
+==Epidemiology and Demographics==
+* The prevalence of cancer of unknown primary origin is approximately [number or range] per 100,000 individuals worldwide.
+* In [year], the incidence of Cancer of unknown primary origin was estimated to be [number or range] cases per 100,000 individuals in [location].
+===Age===
+*Patients of all age groups may develop cancer of unknown primary origin.
+*Cancer of unknown primary origin is more commonly observed among patients aged [age range] years old.
+*Cancer of unknown primary origin is more commonly observed among [elderly patients/young patients/children].
+===Gender===
+*Cancer of unknown primary origin affects men and women equally.
+*[Gender 1] are more commonly affected with cancer of unknown primary origin than [gender 2].
+* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
+===Race===
+*There is no racial predilection for cancer of unknown primary origin.
+*Cancer of unknown primary origin usually affects individuals of the [race 1] race.
+*[Race 2] individuals are less likely to develop Cancer of unknown primary origin.
+==Risk Factors==
+*Common risk factors in the development of cancer of unknown primary origin are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
+== Natural History, Complications and Prognosis==
+*The majority of patients with cancer of unknown primary origin remain asymptomatic for [duration/years].
+*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
+*If left untreated, [#%] of patients with Cancer of unknown primary origin may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
+*Common complications of Cancer of unknown primary origin include [complication 1], [complication 2], and [complication 3].
+*Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with Cancer of unknown primary origin is approximately [#%].
+== Diagnosis ==
+===Diagnostic Criteria===
+*The diagnosis of cancer of unknown primary origin is made when at least [number] of the following [number] diagnostic criteria are met:
+:*[criterion 1]
+:*[criterion 2]
+:*[criterion 3]
+:*[criterion 4]
+=== Symptoms ===
+*Cancer of unknown primary origin is usually asymptomatic.
+*Symptoms of cancer of unknown primary origin may include the following:
+:*[symptom 1]
+:*[symptom 2]
+:*[symptom 3]
+:*[symptom 4]
+:*[symptom 5]
+:*[symptom 6]
+=== Physical Examination ===
+*Patients with cancer of unknown primary origin usually appear [general appearance].
+*Physical examination may be remarkable for:
+:*[finding 1]
+:*[finding 2]
+:*[finding 3]
+:*[finding 4]
+:*[finding 5]
+:*[finding 6]
+=== Laboratory Findings ===
+*There are no specific laboratory findings associated with cancer of unknown primary origin.
-When the cancer cells are poorly differentiated (that is, they look very different from normal cells when viewed under a microscope), the cancer may be either a lymphoma or a germ cell tumor. Lymphomas begin in the lymphatic system (a grouping of lymph glands and lymph vessels found throughout the body that participates in the defense against attack from bacteria, viruses, or other agents); germ cell tumors usually begin in the ovaries and testes.
+*A  [positive/negative] [test name] is diagnostic of cancer of unknown primary origin.
+*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of Cancer of unknown primary origin.
-In patients in whom the primary cancer is eventually found, the lung and pancreas are the most common primary cancer sites. CUP also may be traced to the breast, prostate, colon, or rectum as the primary site.
+*Other laboratory findings consistent with the diagnosis of Cancer of unknown primary origin include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
-Sometimes, however, even when doctors use very sophisticated methods to try to identify the primary site, the part of the body the cancer cells came from cannot be determined. About 2 to 4 percent of all cancer patients have a cancer whose primary site is never found.
+===Imaging Findings===
+*There are no [imaging study] findings associated with cancer of unknown primary origin.
-Identifying the primary tumor site is important because knowing its location and type often helps doctors plan the best treatment. Treatment that is specific to the suspected type of cancer is likely to be more effective. Still, when diagnostic tests have not identified the primary site, doctors must decide whether the potential benefits of more extensive testing outweigh a patient’s discomfort and the financial costs.
+*[Imaging study 1] is the imaging modality of choice for cancer of unknown primary origin.
-CUP is a term that refers to many different cancers. For that reason, treatment depends on where the cancer is found, what the cancer cells look like under a microscope, and the patient’s age and overall physical condition. No method is standard, but chemotherapy, radiation therapy, hormone therapy, and surgery may be used alone or in combination to treat patients who have CUP. Even when the cancer is unlikely to be cured, treatment may help the patient live longer or improve the patient’s quality of life. However, the potential side effects of the treatment must be considered along with the potential benefits.
+*On [imaging study 1], Cancer of unknown primary origin is characterized by [finding 1], [finding 2], and [finding 3].
+*[Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].
+=== Other Diagnostic Studies ===
+*Cancer of unknown primary origin may also be diagnosed using [diagnostic study name].
+*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
+== Treatment ==
+=== Medical Therapy ===
+*There is no treatment for cancer of unknown primary origin; the mainstay of therapy is supportive care.
+*The mainstay of therapy for cancer of unknown primary origin is [medical therapy 1] and [medical therapy 2].
+*[Medical therapy 1] acts by [mechanism of action1].
+*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
+=== Surgery ===
+*Surgery is the mainstay of therapy for cancer of unknown primary origin.
+*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of Cancer of unknown primary origin.
+*[Surgical procedure] can only be performed for patients with [disease stage] Cancer of unknown primary origin.
+=== Prevention ===
+*There are no primary preventive measures available for cancer of unknown primary origin.
+*Effective measures for the primary prevention of cancer of unknown primary origin include [measure1], [measure2], and [measure3].
+*Once diagnosed and successfully treated, patients with Cancer of unknown primary origin are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].
 ==References==
-{{reflist|2}}
+{{Reflist|2}}
+[[Category: Oncology]]
-[[Category:Oncology]]
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