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Flashcards in Cancer of Unknown Primary Deck (49)
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1

How will cancer often present?

As a result of symptoms due to the primary site of the tumour

2

Why might cancer not always present as a result of symptoms due to the primary site of the tumour?

Because sometimes the cancer is able to metastasise before the primary site is large enough to be detected

3

How to carcinomas of unknown primary (CUP) differ from known primary tumours?

They tend to have early dissemination, unpredictable metastatic pattern, aggressive nature, and an absence of symptoms from the primary site

4

What is CUP defined as?

The detection of one or more sites of metastatic tumours for which investigations have failed to identify the primary site

5

What % of cancers are CUP?

Up to 5%

6

What is the median age of presentation of CUP?

60 years

7

What % of patients with CUP present with multiple sites of presentation?

50%

8

What are the most common sites of presentation of CUP?

- Liver
- Bones
- Lungs
- Lymph nodes

9

What is the usual histological diagnosis in CUP?

Adenocarcinoma or poorly differentiated carcinoma

10

What will happen with different tumours, with respect to spread?

They will spread in different patterns

i know this is a bit shit sorry lol

11

What might the differing spread of different tumours be related to?

Chemokine and their receptors expression by the tumour and stromal cells

12

What will the clinical presentation of CUP depend on?

The location of disease sites

13

What non-specific symptoms are common in CUP?

- Anorexia
- Weight loss
- Fatigue

14

What is step 1 in the approach to patients with CUP?

Search for primary site

15

What is step 2 in the approach to patients with CUP?

Rule out potentially treatable or curable tumours

16

What is step 3 in the approach to patients with CUP?

Characterise the specific clinicopathological entity, and then treat the patient

17

In what manner should patients with favourable subsets of CUP be treated?

Consider curative intent

18

In what manner should patients with unfavourable subsets of CUP be treated?

Palliative intent

19

What % of patients with CUP have a primary site identified antemortem?

20%

20

What % of patients with CUP have an unidentified primary site at postmortem?

70%

21

Where are primary sites most frequently detected in CUP?

- Lung
- Pancreas
- GI
- Gynaecological

22

What initial investigations are done in CUP?

- Complete history and physical examination
- FBC
- Serum biochemistry and liver function
- Serum tumour markers
- Urinalysis and stool testing for occult blood
- Chest x-ray
- Symptom-directed endoscopy
- Imaging of thorax, abdomen, and pelvis (MRI, CT, or PET)
- Biopsy for histology (any site of disease)§w

23

What can CUP be classified into on the basis of light microscopy?

- Well to moderately differentiated adenocarcinoma
- Poorly or undifferentiated adenocarcinoma
- Squamous cell carcinoma
- Undifferentiated carcinoma

24

What malignancies can be identified by immunohistochemistry?

- Neuroendocrine tumours
- Lymphomas
- Germ cell tumours
- Melanomas
- Sarcomas
- Serous tumours (ovarian, peritoneal, uterine)
- Embryonal malignancies

25

Who should patients with CUP be referred to to advise on required investigations?

Oncologist

26

Why should patients with CUP be referred to an oncologist for advice on investigations?

There should be concern about over-investigating the patient

27

Why should there be concern about over-investigating the patient with CUP?

It will have a cost effect, and potentially can delay the initiation of appropriate treatment for the patient

28

What needs to be balanced when investigating CUP?

The need for sufficient tests to plan the management and the treatment of the disease

29

How are patients with CUP with an incurable malignancy that is widely metastatic treated?

The combination systemic chemotherapy that is most appropriate

30

What will the choice of treatment depend on in incurable CUP that is widely metastatic?

The best assessment of the likely primary site and consideration of the performance status of the patient