Carcinoma of Unknown Primary

Published on 04/03/2015 by admin

Filed under Hematology, Oncology and Palliative Medicine

Last modified 04/03/2015

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Chapter 94

Carcinoma of Unknown Primary

Summary of Key Points

Evaluation

• No universal agreement exists on the extent of evaluation to search for a primary cancer.

• “Adequate,” early biopsy of a metastatic site is recommended to establish the diagnosis and help direct further workup.

• Basic evaluation includes the following:

• Comprehensive history and physical examination (including breast and pelvic examinations in women and testis and prostate examinations in men).

• Routine laboratory tests, chest-abdominal-pelvic computed tomographic scan, and mammography in women.

• Directed invasive tests based on symptomatology and pathological evaluation of the tumor tissue.

• Judicious pathological assessment of the metastatic tumor sample including directed immunohistochemical markers. Additional molecular markers that have a therapeutic intent are based on clinicopathological evaluation (including KRAS mutational status, Her2 (ERBB2) expression, and epidermal growth factor receptor (EGFR) mutation studies).

• The diagnostic utility of positron emission tomography (PET) is poorly defined; it is beneficial in selected patients.

• The role of tissue of origin molecular profiling assays continues to evolve; these tests are beneficial in selected patients.

Therapy

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