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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Metastatic cancer of unknown primary site (CUP syndrome) comprises 2-5% of all solid malignant tumors. One should distinguish between initial CUP (primary tumor later detected) and the true CUP syndrome (primary tumor remains unknown for a patient's lifetime despite thorough diagnostic work-up). For initial CUP, the most important auxiliary diagnostic method is immunohistochemistry, which should be applied in a two-step algorithmic fashion. Firstly, a small marker panel (including certain cytokeratins) yields a preliminary categorization of the tumor. Secondly, selective, organ-specific markers (including recently established markers such as TTF-1 and uroplakin) and further tumor group markers may further subclassify or even identify the primary tumor. Although they are a heterogeneous group, true CUP tumors share some unique biological features such as an early metastatic phenotype and unusual metastasis patterns, and they mostly have a very poor prognosis. Even autopsy reveals the primary site in only 55-80% of cases, most commonly in the lung and pancreas. True CUP tumors, predominantly adenocarcinomas and poorly differentiated carcinomas, may exhibit unusual immunohistochemical phenotypes. Nevertheless, careful histologic and immunohistochemical examination are essential not only for determining the actual tumor immunophenotype but in particular for identifying therapy-responsive subgroups such as neck lymph node CUP, axillary lymph node CUP of females, neuroendocrine CUP, and germ cell tumor CUP of males. For CUP syndrome, future interdisciplinary research efforts are needed, such as gene expression profiling using microarrays. It is thus to be hoped that pathology will contribute to the elucidation of the largely still enigmatic pathogenesis of the CUP syndrome, to improve its diagnosis and classification and, finally, to aid in the development of more specific therapeutic regimens.
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PMID:[CUP syndrome: are there advances?]. 1803 82

Despite the growing array of sophisticated diagnostic tools for establishing a diagnosis of human neoplasia, 2-6% of all cancer patients still present metastatic cancer of which detailed investigations fail to identify the primary anatomic site. The site is found in less than 25% of patients before death and frequently goes undiscovered at post-mortem examination. At the time of first diagnosis with carcinoma of unknown primary site, usually more than 80% of patients present with dissemination. Prognosis depends on the site(s) involved and is unaffected by whether the primary site is ever found. Node dissection may be curative for patients with metastases to peripheral lymph nodes. Objective long-term response is possible in combination with chemotherapy in patients with small-cell malignancies, peritoneal carcinomatosis (in women), or poorly differentiated carcinomas involving external lymph nodes, mediastinum, or retroperitoneum but without metastases to viscera or bone. Toxic therapies are recommended only for palliation of symptoms and maintaining quality of life support in patients with good functional status. Patients should be encouraged to participate in clinical trials for novel therapies.
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PMID:[Carcinoma of unknown primary site (CUP syndrome)]. 1858 37

The management of patients with cervical node metastasis (CNM) from carcinoma of unknown primary (CUP) often includes several radiographic studies and invasive procedures that are only successful in detecting an occult primary tumour in less than 25% of the cases. In this prospective study we have assessed the role of total body positron emission tomography (PET) using an 18-F-fluorodesoxyglucose (FDG) in the detection of primary tumours in patients with metastases from CUP. Thirteen patients with lymph node metastases from cytologically verified CUP have undergone total body FDG PET which confirmed the possibility of lymph nodal lesion; all patients have also undergone conventional imaging with CT and/or MRI. The data obtained with the FDG-PET method have subsequently been confirmed both by the histopathological examination and by the clinical course of the disease. The current work aims at assessing and defining the effectiveness of the FDG-PET method during the diagnostic work-up of laterocervical metastasis from CUP conventionally examined with CT and/or MRI; based on our results, we recommend a flow-chart for the clinical-diagnostic management of the patient affected by laterocervical metastasis in the absence of known primary.
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PMID:18-FDG PET in the diagnosis of laterocervical metastases from occult carcinoma. 1858 94

To evaluate the efficacy and feasibility of irradiation with intensity-modulated radiotherapy (IMRT) technique in patients with head and neck carcinoma of unknown primary (HNCUP). Between February 2000 and November 2006, 22 consecutive patients diagnosed with HNCUP were treated with IMRT. Of these, four patients were excluded because two of them underwent IMRT only as a boost and the other two had distant metastasis at presentation and were treated palliatively. Of the remaining 18 patients eligible for analysis, 6 had definitive IMRT and 12 had postoperative IMRT (8 with neck dissection and 4 with excisional biopsy). One patient with abnormal lymph node found unexpectedly during carotid endarterectomy was treated to ipsilateral neck only. The target volumes for the other 17 patients include nasopharynx, oropharynx, retropharyngeal lymph nodes, and bilateral neck. In 1 patient who had extensive lymph node involvement, the hypopharynx and the larynx were defined as target. In all other patients the larynx including hypopharynx were defined as dose-limiting structures. The parotids, cervical esophagus, spinal cord, brain stem, optic nerves and the orbits are also outlined as dose-limiting structures. All patients completed their treatment without interruption and severe complications. With a median follow-up time of 25.5 months, 2 patients had persistent cervical lymphadenopathy and 2 had distant metastases. Another patient developed a lung cancer and a second pyriform sinus cancer 25 months after treatment. The 2-year overall survival, regional recurrence-free survival and distant metastases-free survival were 74.2%, 88.5%, and 88.2%, respectively. Six patients had prophylactic percutaneous endoscopic gastrostomy (PEG) tubes placed before radiation. Most had PEG tubes removed within 7 months after the completion of treatment. IMRT delivered to comprehensive bilateral neck and putative mucosal site (including nasopharynx, oropharynx, and retropharyngeal lymph nodes) appears to be effective for patients with HNCUP. Our preliminary results show that such approach does not compromise local-regional control. Further studies with more patients and longer follow-up are necessary to validate this approach.
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PMID:Unknown primary head and neck cancer treated with intensity-modulated radiation therapy: to what extent the volume should be irradiated. 1880 8

Carcinoma of unknown primary (CUP) is one of the 10 most frequent cancers worldwide. It constitutes 3-5% of all human malignancies. Patients with CUP present with metastases without an established primary site. CUP manifests as an heterogeneous group of mainly epithelial cancers recognised by distinct clinicopathological entities. The diagnostic work-up includes extensive histopathology investigations and modern imaging technology. Nevertheless, the primary tumour remains undetected most of the time. Molecular diagnosis with DNA microarrays demonstrates high sensitivity, but its prognostic contribution is still uncertain. Certain clinicopathological CUP entities are considered as favourable sub-sets responding to systemic platinum-based chemotherapy or managed by locoregional treatment. These sub-sets are: the poorly differentiated carcinomas involving the mediastinal-retroperitoneal nodes, peritoneal papillary serous adenocarcinomatosis in females, poorly differentiated neuroendocrine carcinomas, isolated axillary node adenocarcinomas in females or cervical nodal involvement by a squamous cell carcinoma. Patients who belong to the non-favourable sub-sets have a worse prognosis.
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PMID:Carcinoma of unknown primary (CUP). 1897 67

Carcinoma of unknown primary (CUP) is an intriguing clinical finding defined as biopsy-proven metastasis from a malignancy in the absence of an identifiable primary site after a complete clinical workup. CUP is a relatively common clinical entity, accounting for approximately 3-5% of all cancer diagnoses, and consists of a heterogeneous group of tumors that have acquired the capacity to metastasize before the development of a clinically evident primary lesion. The mechanisms responsible for early metastasis and lack of a detectable primary tumor are largely unknown. Although remarkable tools have been developed for immunohistological classification of CUP on the basis of the likely tissue of origin, data on molecular pathogenesis and biology of this disorder are rare. A wide variety of chromosomal aberrations are seen in CUP, with aberrations of chromosomes 1, 6, 7, and 11 having been most frequently described. 66-75% of CUP express epidermal growth factor receptor while overexpression of Her2/neu seems to be rare. In contrast to most other tumor entities p53 mutations have been found only in a minority of CUP tumors. Recently, several independent studies have demonstrated proof of principle for the use of gene expression microarrays in identifying a primary site for CUP. Therefore, gene expression and also genomic profiling tools represent promising analytical approaches to assist with the management of CUP patients.
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PMID:[CUP syndrome: molecular pathogenesis and biology]. 1913 75

Patients with carcinoma of unknown primary site are heterogeneous with respect to clinical and pathologic features. Within this diverse group, specific clinical and/or pathologic features can be used to define several subsets with favorable prognoses. Specific subsets include women with peritoneal carcinomatosis, women with isolated axillary lymph node metastases, adenocarcinoma presenting as a single metastatic lesion, young men with features of extragonadal germ cell tumor, squamous carcinoma involving cervical or inguinal lymph nodes, and neuroendocrine carcinoma. Prospective identification of patients in these favorable subgroups allows the most effective treatment to be selected. This review summarizes current recommendations for the evaluation and treatment of patients in each of these favorable prognostic subsets.
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PMID:Treatment for patients with unknown primary cancer and favorable prognostic factors. 1917 87

Carcinoma of unknown primary origin (CUP) is a heterogeneous group of cancers defined by the presence of metastatic disease with no identified primary tumor at presentation. Identifying patients with prognostically favorable disease is important, since they may derive substantial benefit, including prolonged survival, from directed treatment. In CUP cases, a focused search for the primary tumor is recommended. Whether CUP is a distinct molecular genotype-phenotype relative to metastases of known cancers is unknown. However, use of a robust immunohistochemical panel and emerging molecular data may permit development of a tailored treatment algorithm for CUP patients that will include appropriate use of targeted agents.
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PMID:Carcinoma of unknown primary origin. 1926 1

Patients with carcinoma of unknown primary (CUP) present with metastatic disease for which the primary site cannot be found, despite extensive standard investigation. Here, we describe the development and implementation of the first clinically available microarray-based test for this cancer type (CUPPrint), based on 633 individual tumors representing 30 carcinoma and 17 noncarcinoma classes. Tissue of origin prediction for either fresh frozen or paraffin-embedded tumor samples is achieved with the use of a custom 8-pack 1.9k microarray and robust classification algorithm. An expression profile of 495 genes was used to predict tumor origin by applying a k-nearest neighbor algorithm. Internal cross-validation and analysis of an independent, previously published, 229-sample dataset revealed that clinically informative predictions were made for up to 94% of samples analyzed. Analysis of 13 previously published CUP specimens yielded predicted tumor origins that supported the clinical suspicion in 12 cases (92%). Microarray profiling presents a promising tool to assist in the identification of the primary tumor and might direct a more tailored treatment for CUP patients.
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PMID:Implementation of a novel microarray-based diagnostic test for cancer of unknown primary. 1953 16

18F-FDG PET plays an increasing role in diagnosis and management planning of head and neck cancer. Hybrid PET/CT has promoted the field of molecular imaging in head and neck cancer. This modality is particular relevant in the head and neck region, given the complex anatomy and variable physiologic FDG uptake patterns. The vast majority of 18F-FDG PET and PET/CT applications in head and neck cancer related to head and neck squamous cell carcinoma. Clinical applications of 18F-FDG PET and PET/CT in head and neck cancer include diagnosis of distant metastases, identification of synchronous 2nd primaries, detection of carcinoma of unknown primary and detection of residual or recurrent disease. Emerging applications are precise delineation of the tumor volume for radiation treatment planning, monitoring treatment, and providing prognostic information. The clinical role of 18F-FDG PET/CT in N0 disease is limited which is in line with findings of other imaging modalities. MRI is usually used for T staging with an intense discussion concerning the preferable imaging modality for regional lymph node staging as PET/CT, MRI, and multi-slice spiral CT are all improving rapidly. Is this review, we summarize recent literature on 18F-FDG PET and PET/CT imaging of head and neck cancer.
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PMID:Clinical Applications of FDG PET and PET/CT in Head and Neck Cancer. 1970 28


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