Flashcards in Blue Book: Primary Unknown (Cancer of unknown origin) Deck (16)
What percentage of proven malignancies can the primary site remain unknown despite standard investigations?
For the following queue cards. Name the common primaries that would be found at the given site of metastases.
Breast, Lung, Colon,
Breast, Lung, Kidney
Breast, Lung, Melanoma
Breast, Bronchus, Kidney, Prostate, Thyroid
Ovary, GI tract (esp stomach), pancreas
High cervical nodes
head & neck, thyroid, lung
head & neck, lung, breast, GI tract
breast, lung, melanoma
ovary, prostate, ano-recta,, vulva
What is the common histology of carcinomas of unknown origin?
Adenocarciomas or undifferentiated tumours
Most likely primary for:
1) GI tract (including pancreas), breast, ovary, lung.
2) Lung, head and neck.
Name the likely diagnosis based on the following 'syndromes':
a) Young men + disease in midline (para-aortic/mediastinal/neck/brain nodes)
b) Women with axillary or thoracic nodes.
c) women with abdominal carcinomatosis
d) men with boney mets
e) multiple moderate size abnormal nodal sites
When these syndromes are identified what management should occur?
a) germ cell tumour (curable with chemo!)- used tumour markers
b) breast cancer
c) ovarian cancer
d) prostate cancer (do rectal exam & PSA order bone scan)
Do simple investigations only taking a few days, then start empirical treatment for the given cancer.
What standard investigations can be offered when clinically appropriate?
• Full clinical assessment and examination to include breast, nodal, skin, genital,
rectal and pelvic examination
• Full blood count, urea, electrolytes and creatinine; liver function tests; calcium;
urinalysis, lactate dehydrogenase
• Chest x-ray
• Myeloma screen (when there are isolated or multiple lytic bone lesions)
• Symptom-directed endoscopy
• CT scan of chest, abdomen and pelvis
• Prostate specific antigen (PSA) in men
• Cancer antigen 125 (CA125) in women with peritoneal malignancy or ascites
• Alpha-fetoprotein (AFP) and human chorionic gonadotrophin (hCG) (especially in
the presence of midline nodal disease)
• Testicular ultrasound in men with presentations compatible with germ cell
• Biopsy and standard histological examination, with immunohistochemistry
where necessary, to distinguish carcinoma from other malignant diagnoses
Chemotherapy for adult solid tumour + GI tumours