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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.
- 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%
- sensitivity of 81-84% and for specificity of 83-84%.
- favourable clinical effects in 27% of patients and unfavourable effects in 5%
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
- 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
Second Phase Investigations
Breast imaging - if suspect breast, mammography first, then MR if norm
- Intrapulmmonary nodules
- Bronchosocpy, VATS if normal
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