Unknown Primary Cancer
Cancer starts when cells in the body begin to grow out of control. Cells in nearly any part of the body can become cancer, and can spread from their primary site (the part of the body where the cancer started), to one or more metastatic sites (other parts of the body).
Sometimes it’s not clear where a cancer may have started. When cancer is found in one or more metastatic sites but the primary site cannot be determined, it is called a Cancer of Unknown Primary (CUP).
This term is used to define a heterogeneous group of patients that represents up to 5% of histologically confirmed carcinomas in which a primary tumor is detected, so the prevalence is actually much higher (historically only is defined carcinoma as unknown source if that source is behind conducting an autopsy, which is not always done).
Since the exact type of cancer is not known, it’s hard to identify factors that might affect risk for cancer of unknown primary. Furthermore, these cancers are also a very diverse group, making this issue even more complicated. But there are some risk factors associated with the part of the body where Cancer of Unknown Primary had found to have started.
Risk factors for Cancer of Unknown Primary include:
- Smoking is probably the most important risk factor for Cancer of Unknown Primary (more than half of patients with Cancer of Unknown Primary have a history of smoking). Besides, when autopsy studies are done, many Cancer of Unknown Primary are found to have started in the pancreas, lungs, kidneys, throat, larynx, or oesophagus, for which smoking increases the risk of having cancer.
- Diet, nutrition, and weight are factors that also have been linked to Cancer of Unknown Primary because some of them are eventually found to have started in the stomach, colon, rectum, or ovaries.
- Exposure to ultraviolet radiation in sunlight may be another source of Cancer of Unknown Primary, because is high linked to Melanoma, an aggressive type of skin cancer.
Signs and Symptoms
The signs and symptoms of a cancer of unknown primary vary depending on which organs it has spread to. It’s important to note that none of the symptoms listed below is caused only by Cancer of Unknown Primary. In fact, they are more likely to be caused by something other than cancer.
Signs and symptoms of Cancer of Unknown Primary may include:
- Swollen, firm, non-tender lymph nodes
- A mass in the abdomen that can be felt or a feeling of “fullness”
- Shortness of breath
- Pain in the chest or abdomen
- Bone pain
- Skin tumors
- Low red blood cell counts (anemia)
- Weakness, fatigue, poor appetite, and weight loss
The prognosis for patients with CUP is poor. As a group, the median survival is approximately 3 to 4 months with less than 25% and 10% of patients alive at 1 and 5 years, respectively. CUP is represented by a heterogeneous group of diseases all of which have presented with metastasis as the primary manifestation. Although the majority of diseases are relatively refractory to systemic treatments, certain clinical presentations of CUP carry a much better prognosis. In each instance, distinct clinical and pathologic details require consideration for appropriate, potentially curative, management. Although only a minority of patients will have curable disease or a disease for which there is substantial palliative benefit, the appropriate use of special diagnostic pathology will identify patients for whom directed therapy will provide the best possible chance for response.
PLEASE NOTE: EARLY DIAGNOSIS IN CANCER IS VERY IMPORTANT BECASUSE CANCER THAT’S DIAGNOSED AT AN EARLY STAGE, BEFORE IT’S HAD THE CHANCE TO GET TOO BIG OR SPREAD IS MORE LIKELY TO BE TREATED SUCCESSFULLY. IF THE CANCER HAS SPREAD, TREATMENT BECOMES MORE DIFFICULT, AND GENERALLY A PERSON’S CHANCES OF SURVIVING ARE MUCH LOWER.
State of the Art
Current studies argue that to define a carcinoma as Cancer of Unknown Primary requires the patient to present a histologically documented metastatic cancer, that is, a detailed health record with a thorough physical examination including: pelvic and rectal exams; a blood test with complete biochemistry; an urinalysis; a test for fecal occult blood; a review of the biopsy using immunohistochemistry; a chest radiography; and an abdominal CT scan and/or a mammography, as appropriate.
All these diagnostic tests and complementary examinations to which will be submitted to the patient, are intended to determining the primary tumor to be treated in the most suitable way, something that unfortunately won’t be achieved in most cases, which results in high stress levels, as well a very substantial economic costs.
For this reason, in most cases the number of scans is limited to those that can provide a clinical benefit to the patient, because currently, the treatment of patients with Carcinoma of Unknown Origin has a very poor prognosis and provides meager profits, what recommends to focus all effors in determine which chemotherapy scheme can provide the maximum benefit with minimal toxicity.
Our MBDAA for Unknwon Primary Dx test follows the same principles as our MBDAA test for Lung Cancer, ie identify patients at high risk from a simple blood test for detection early Primary Cancer that produces it, and it is based on the combined count of the AFP, CA 15.3, CA 19.9, CA 125, CEA, CYFRA, HE4, NSE, ProGRP, PSA, fPSA, p2PSA, hK2, SCC, S100 and TAG-72 tumor markers; over expression of Post-DRE PCA3 and T2:ERG genes; ALAT, ASAT, Bilirubin, Creatinine and GGT serum levels; comorbidities; and smoking and drinking habits.
Its aim is to help the differential diagnosis of suspected locally advanced tumor or CUP, distinguishing cases without neoplasia of malignant tumors noninvasively, quickly and at low cost. This leads to a reduction average hospital stay (cost 600 Euro/Day) and the necessary tests, with a diminution also morbidity for the patient.
Moreover, in cases with neoplasia, our MBDAA for Unknwon Primary Dx test orients the possible origin of the tumor by more than 60% of cases. Knowing the origin of the tumor can facilitate diagnosis and therapy to be applied not as generic, but specific to the tumor in question.
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