Unknown primary

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Author:
esmond
ID:
252795
Filename:
Unknown primary
Updated:
2015-06-29 11:22:36
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Unknown primary
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Unknown primary
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  1. adenocarcinoma of unknown origin immunochemistry
    Thyroid transcription factor-1 (TTF-1) - may be present in bronchial carcinoma

    Placental alkaline phosphatase (PLAP) - may be present in some germ cell tumours

    Oestrogen receptor (ER; women only) - may be present in breast carcinoma

    PSA (men only) - may be present in prostate cancers

    Cytokeratin 7 (CK7), CK20.
  2. Stats
    • 4% of patients with cancer the origin of the primary tumour has not been identified
    • 8% of cancer related deaths
    • overall one year survival rate is about 16% and five year survival is about 8%
  3. PET scanning
    • sensitivity of 81-84% and for specificity of 83-84%.
    • favourable clinical effects in 27% of patients and unfavourable effects in 5%
  4. Initial Phase Investigations
    full history &examination, which will usually include assessment of breasts, lymph nodes, skin, genitals, rectum, and pelvis

    Blood tests - FBS,U&Es,LFTs,Ca,LDH

    Urinalysis

    • ImagingĀ 
    • CT neck - pelvis
    • Myeloma screen (when there are isolated or multiple lytic bone lesions)
    • Gastrointestinal endoscopy (when you suspect upper or lower GI cancer)
    • Testicular ultrasound (when you suspect germ cell tumours)

    • Tumour markers
    • You should not order tumour markers unless you have clinical suspicion of a specific diagnosis

    Biopsy - where will change result of mx
  5. Second Phase Investigations
    Breast imaging - if suspect breast, mammography first, then MR if norm

    PET

    Immunochemistry

    • Intrapulmmonary nodules
    • Bronchosocpy, VATS if normal

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