Blue Book: Primary Unknown (Cancer of unknown origin) Flashcards Preview

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Flashcards in Blue Book: Primary Unknown (Cancer of unknown origin) Deck (16)
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1

What percentage of proven malignancies can the primary site remain unknown despite standard investigations?

10%

2

For the following queue cards. Name the common primaries that would be found at the given site of metastases.

Liver

Breast, Lung, Colon,

3

Lung

Breast, Lung, Kidney

4

Brain

Breast, Lung, Melanoma

5

Bone

Breast, Bronchus, Kidney, Prostate, Thyroid

6

Peritoneal

Ovary, GI tract (esp stomach), pancreas

7

High cervical nodes

head & neck, thyroid, lung

8

lower cervical/supra-clavicular

head & neck, lung, breast, GI tract

9

Axillary

breast, lung, melanoma

10

Inguinal

ovary, prostate, ano-recta,, vulva

11

What is the common histology of carcinomas of unknown origin?

Adenocarciomas or undifferentiated tumours

12

Most likely primary for:
1) Adenocarcinoma
2) Squamous

1) GI tract (including pancreas), breast, ovary, lung.

2) Lung, head and neck.

13

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)

e) lymphoma

Do simple investigations only taking a few days, then start empirical treatment for the given cancer.

14

What standard investigations can be offered when clinically appropriate?
(Theres loads)

• 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
tumours
• Biopsy and standard histological examination, with immunohistochemistry
where necessary, to distinguish carcinoma from other malignant diagnoses

15

Management

Chemotherapy for adult solid tumour + GI tumours

16

Prognosis of cancer of unknown origin

Poor prognostic features

3-4 months.
5 year survival is less than 10%

male, ↑N. of organ sites, adenocarcinoma histology, hepatic involvement.