Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors review all the cases of Carcinoma of Unknown Primary Site admitted to a medical service during a 3-year period (1987-1989). These cases represented 9% of all the neoplastic diseases admitted during the aforementioned period. Most of the patients presented extensive metastatic disease. The main histologic type was adenocarcinoma. The most useful of all the ancillary exams requested for primary localization and staging purposes was the computerized axial tomography (CT). The primary localization was achieved in two cases (one while the patient was still alive, and one on autopsy). The low performance status of the patients, together with the existence of advanced metastatic disease, precluded more than palliative therapy in most of the cases. The mortality of this series was 40% (4/10), with 3 autopsies performed. The authors compare their experience with the literature available, focusing the need for a work-up based on strict diagnostic criteria based on the histology and supported by specific laboratory tests. They also underline the value of the CT scan as the most useful exam in these circumstances.
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PMID:[Unknown primary neoplasm: a retrospective 3-year study at a service of internal medicine]. 195 Jun 58

We identified 26 cases of metastatic prostatic carcinoma in supradiaphragmatic lymph nodes from 1972-1987. All involved nodes (15 supraclavicular, eight cervical, two axillary, and one mediastinal) were taken from the left side. Of those cases with available data, serum acid phosphatase was normal in five of 21 (24%). Seven of 20 (35%) had no evidence of bone metastases. Rectal examination was normal in eight of 19 cases (42%). While seven cases had a history of prostate cancer, the rest presented with enlarged nodes alone or with simultaneous urinary obstructive symptoms. Eighteen patients died following node biopsy (mean 19.8 months, range 1-46 months). Twenty-two of 26 metastases were high grade and often were not histologically suggestive of prostate carcinoma. In general, immunohistochemical staining for prostate-specific acid phosphatase (PSAP) was more intense than for prostate-specific antigen (PSA), in contrast to several other reports using these antisera. Metastatic prostate carcinoma should be ruled out by using immunoperoxidase for PSA and PSAP in all men over 45 presenting with carcinoma of unknown primary origin in left-sided supradiaphragmatic lymph nodes, even in the absence of bony disease, elevated serum acid phosphatase (SAP), abnormal rectal examination, and a histologic picture suggesting prostate carcinoma.
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PMID:Metastatic prostatic carcinoma to supradiaphragmatic lymph nodes. A clinicopathologic and immunohistochemical study. 243 55

One hundred patients with metastatic carcinoma of unknown primary were analyzed to assess the importance of prognostic factors on survival. Patients were treated with cytostatic combinations, single drugs, or symptomatic care only. Response in the treatment groups ranged from 10% to 33%. The median survival of all patients was 124 days. In a univariate analysis good performance status, the presence of lymph node metastases, and the absence of liver metastases favorably influenced survival. In a Cox proportional hazards model, good performance status contributed significantly to a better survival. In addition there was a trend for female patients, patients with lymph node metastases, and patients without liver metastases to survive longer. These patient subsets deserve optimal treatment despite the dismal prognosis of this disease.
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PMID:Treatment and prognosis of metastatic carcinoma of unknown primary: analysis of 100 patients. 274 91

Twenty-nine patients with poorly differentiated neuroendocrine tumors of unknown primary site were seen at Vanderbilt Medical Center between May 1977 and February 1987. All patients had pathologic findings typical of neuroendocrine tumors by electron microscopy (22 patients), light microscopy (6 patients), or immunochemical staining (1 patient). Patient age ranged from 18 to 77 years; 21 were men and 8 were women; and 12 had no history of tobacco use. Seventeen patients had metastatic tumor at two or more locations. Common metastatic sites included the retroperitoneum, lymph nodes (particularly cervical), and mediastinum. In most patients, these neoplasms showed an aggressive biology, with rapid onset of symptoms and rapid growth of metastases. Major responses were seen in 18 of 25 patients who received combination chemotherapy; 6 patients achieved a complete response. Three patients remain disease-free more than 24 months after completing therapy. Four patients with single sites of disease received local therapy only; all remain disease-free 1 to 10 years after completion of therapy. In 4 patients, specific tumor types were eventually recognized: small cell lung cancer, 1; gastrointestinal carcinoid tumor, 2; and extragonadal germinal tumor with predominant neuroendocrine differentiation, 1. In the remaining 25 patients, no well-recognized type of neuroendocrine tumor was identified. Recognition of these tumors broadens the spectrum of neuroendocrine neoplasia, and also identifies a distinct subset of patients with poorly differentiated carcinoma of unknown primary site. Although optimal therapy remains undefined, these patients are usually responsive to combination chemotherapy, and long-term survival is attainable in a minority.
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PMID:Poorly differentiated neuroendocrine carcinoma of unknown primary site. A newly recognized clinicopathologic entity. 284 95

We studied 302 consecutive autopsied patients who presented with carcinoma of unknown primary origin. The most frequent metastatic sites were the nodes, lung, and bone. The primary site was identified while patients were alive in 27% and at autopsy in 57%; the site remained unidentified in 16%. The pancreas (26.5%), lung (17.2%), kidney (4.6%), and colorectum (3.6%) were the most frequent primary sites, but the reliability of diagnostic tests used in the search for this site was disappointing. Survival was identical in patients whose primary site was discovered while alive, at autopsy, or remained unknown. The number of metastases at presentation was the major prognostic factor. Analysis of autopsy data demonstrated that patients with carcinoma of unknown primary origin pursue a different course than expected when the primary site is the first manifestation of the disease. On the basis of these results and the results of other modern series, we suggest an approach consisting of a limited initial workup but with greater emphasis on modern histochemistry studies and immunohistopathologic and other kinetic and morphologic parameters to understand the patient tumor characteristics better and base the clinical management on an individual basis.
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PMID:Early metastatic cancer of unknown primary origin at presentation. A clinical study of 302 consecutive autopsied patients. 304 43

Metastasis of unknown origin (MUO) constitutes between 5% and 10% of all noncutaneous cancers. An MUO is defined as a metastatic tumor for which the site of origin is not suggested by thorough history, physical examination, chest x-ray studies, routine blood and urine studies, and histologic evaluation. Two major groups of MUO can be defined: MUO to lymph nodes only (N1-3), and MUO to visceral sites. The prognosis may be quite good for patients with MUO limited to lymph nodes in the mid to high cervical, axillary, and groin areas. However, MUO in other lymph node areas is far more serious, with the possible exception of that in patients with a new syndrome, i.e., "advanced poorly differentiated carcinoma of unknown primary origin." There is some suggestion that these patients may respond to cisplatin-based combination chemotherapy. Patients with MUO to visceral sites have a poor prognosis. However, metastases from some primary tumors are sensitive to chemotherapy and a limited search for these tumors should be undertaken. These tumors include leukemia-lymphoma, germ cell tumors, small cell carcinoma of the lung, adenocarcinomas of the breast, ovary, endometrium, thyroid, or prostate, and possibly adrenal carcinoma. We start by reviewing the biochemical events of metastasis that may be targets for therapy. The importance of a correct tissue diagnosis is then considered, including the role of standard histochemistry, electron microscopy, enzyme histochemistry, and immunohistochemistry. The relatively limited value of radiologic tests in localizing the primary site of origin of the tumor is emphasized, as well as the limited role of currently available biomarkers. We conclude by discussing the treatment of each of the subtypes of MUO.
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PMID:Metastasis of unknown origin. 306 82

Two patients with poorly differentiated metastatic cancer were shown to have metastatic thyroid carcinoma. Each patient had poorly differentiated cancer and remaining thyroid tissue in the neck. The diagnosis was secured using the immunoperoxidase technique with an antibody against thyroglobulin. The proper evaluation of patients with carcinoma of unknown primary involves specific tissue identification using special techniques in pathology.
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PMID:Identification of unsuspected thyroid carcinoma using immunoperoxidase for thyroglobulin. 352 23

Management of carcinoma of unknown primary site (CUPS) is determined by tumor histologic characteristics and clinical presentation. Undifferentiated carcinoma or adenocarcinomas comprise the majority of these tumors with typical occult primary sites in the pancreas, lung, liver, or gastrointestinal tract. Elaborate diagnostic evaluations are of little benefit and lack of impact on treatment. Squamous carcinomas usually represent lymphatic metastases of head and neck tumors, which may be controlled for extended periods by irradiation. Unusual presentations of CUPS in which the histologic condition is adenocarcinoma or undifferentiated carcinoma are important to recognize because of the potential for specific therapy or cure of such entities as breast cancer and germ cell tumors.
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PMID:Carcinoma of unknown primary site: a clinical enigma. 705 60

Radiotherapists are often asked to irradiate patients with metastases in lymph nodes in the cervical area from an unknown primary carcinoma. In our department we use indirect mirror examination, finger palpation and cytology of smears from the nasopharynx, in case the primary is located there. The same method is used before radiotherapy of patients with nasopharyngeal carcinoma, during treatment and at their follow up examinations. We found cytology of the nasopharynx very useful in managing these patients.
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PMID:Papanicolaou test of the nasopharynx in a radiotherapy department. 743 90

We have retrospectively evaluated six serum tumor markers in 85 patients with carcinoma of unknown primary. The serum levels of carcinoembryonic antigen (CEA), CA 19-9, CA 15-3, CA 125, beta-chorionic gonadotropin (beta-HCG) and alpha-fetoprotein (AFP) were related with the histological pattern (undifferentiated carcinoma or adenocarcinoma), the number and the site of metastases, as well as the response to chemotherapy and the patients' survival. More than 40% of the patients had increased serum levels of all six tumor markers, except of AFP which was found to be increased in only 17% of them. Increased levels of CA 19-9 were related to metastatic adenocarcinoma, whereas CA 19-9 and CA 15-3 had a relationship with more advanced disease. Patients with liver involvement had higher mean levels of CEA and CA 19-9 as compared to those with nodal disease. None of these markers was found to have a predictive value for response to chemotherapy or survival. Although the present study has a retrospective nature, it allows us to conclude that patients with CUP have a nonspecific over-expression of the above serum tumor markers and that routine use of these markers does not offer any diagnostic or prognostic assistance.
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PMID:Evaluation of six tumor markers in patients with carcinoma of unknown primary. 750 76


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