Metastatic Disease of Unknown Primary

Question 1

Which investigations should be performed in all patients with metastatic disease of unknown primary?

Answer 1

FBC, U+E, LFT, calcium, urinalysis, LDH
CXR
CT CAP
AFP + hCG

Question 2

What investigation should be performed if lytic bone lesions are detected in metastatic disease of unknown primary?

Answer 2

Myeloma screen

Question 3

What investigations should be performed directed towards symptoms in metastatic disease of unknown primary?

Answer 3

Endoscopy

Question 4

What investigation should be performed in men with metastatic disease of unknown primary?

Answer 4

PSA
Testicular US (in men with germ cell tumours)

Question 5

What investigation should be performed in women with metastatic disease of unknown primary?

Answer 5

CA 125 (if peritoneal malignancy or ascites)
Mammography (if clinical or pathological features compatible with breast cancer)