Re: [MOL] CUP Series Part 1 [03459] Medicine On Line


[Date Prev][Date Next][Thread Prev][Thread Next][Date Index][Thread Index]

Re: [MOL] CUP Series Part 1



Dear LIl

Did not receive Part II that I can see, although I am not seeing as well
as I should, LOL. Pls resend it was very interesting.

God Bless
marty

firefly wrote:
> 
> Marty:  Did part 2 of this series come accross the mol line?  I knew this
> was Barbs problem.  I try to find something for everyone at some point.
> Take care and let me know.  Your friend, lillian
> 
> -----Original Message-----
> From: Martin Auslander <fitecancer@earthlink.net>
> To: mol-cancer@lists.meds.com <mol-cancer@lists.meds.com>
> Date: Friday, February 26, 1999 10:26 AM
> Subject: Re: [MOL] CUP Series Part 1
> 
> >DEar Lil,
> >
> >This information is very useful as you know my Barb is in that category,
> >CUP, carcinoma of an unknown primary. Thank you. I believe there are
> >others here who fall into that category. May I add, while the syndrome
> >accounts for 3-5% of all cancers diagnosis, there is much hope that we
> >should believe as well, that there are many treatments and drugs
> >available. The key is to get the metastasis under control. In many cases
> >the primary tumor over a period of time disappears. The essential
> >treatment is in curing or controlling the metastais. Thank you again for
> >this information.
> >
> >God Bless
> >marty auslander
> >
> >> firefly wrote:
> >>
> >> Abstract
> >>
> >> Carcinoma of unknown primary site is a common clinical syndrome and
> >> accounts for 3%-5 % of all cancer diagnoses. In addition to physical
> >> examination, routine laboratory tests, and chest radiograph, patient
> >> work-up should include computerized tomography of the abdomen and
> >> directed evaluation based upon signs and symptoms. Routine
> >> radiographic or endoscopic evaluation of asymptomatic areas is
> >> unrewarding. A number of patient subsets with specific treatment
> >> implications can be identified on the basis of clinical and pathologic
> >> features. Identification and treatment of these subsets (totaling
> >> approximately 40% of all patients with unknown primary tumors) is
> >> detailed in this article. For the remainder of patients, empiric
> >> chemotherapy is indicated unless performance status is poor. Recent
> >> experience with taxane-containing regimens suggests higher response
> >> rates and modest prolongation of survival. Ongoing trials are
> >> evaluating other new antineoplastic agents, in hopes of further
> >> improving therapy.
> >>
> >> Introduction
> >>
> >> Cancer of unknown primary site is a common clinical syndrome,
> >> accounting for approximately 5% of all cancer diagnoses. Patients
> >> usually arrive at medical attention due to systemic symptoms or
> >> specific symptoms resulting from one or more sites of metastatic
> >> involvement; they should be considered to have cancer of unknown
> >> primary site after standard evaluation fails to identify the primary
> >> tumor site. Since most patients with cancer of unknown primary site
> >> have epithelial malignancy, the incidence of this syndrome increases
> >> with age, and the most common histologic diagnosis is adenocarcinoma.
> >>
> >> Although this syndrome is relatively common, little attention has been
> >> given to improving therapy. This results in part from widespread
> >> nihilism regarding the prognosis of these patients. In addition, early
> >> attempts at systemic therapy yielded low response rates and had
> >> negligible effect on survival. However, it is now clear that this is a
> >> heterogeneous group of patients, and contains subsets of patients who
> >> benefit from specific treatment. Many of these patients can be
> >> identified using clinical and pathologic criteria, and require
> >> specific therapy. In the remaining patients who do not fit into any
> >> specific "treatable subset," recent empiric therapies incorporating
> >> new chemotherapeutic agents have yielded encouraging results, with
> >> early reports indicating higher response rates and improved survival.
> >>
> >> In this review, the recommended clinical and pathologic evaluation of
> >> the patient with cancer of unknown primary site is detailed.
> >> Recommended treatment of specific subsets, as well as the evolving
> >> role of empiric treatment for patients who do not fit into any
> >> specific subset, are also discussed.
> >>
> >> Initial Diagnosis and Staging
> >>
> >> The typical patient with cancer of unknown primary site develops
> >> symptoms at a metastatic site, and comes to the attention of the
> >> medical oncologist after a biopsy has established a diagnosis of
> >> metastatic cancer. All patients presenting with metastatic carcinoma
> >> of unknown primary site should have a limited routine workup including
> >> a thorough history, physical examination, complete blood counts,
> >> chemistry profile, and chest radiograph. Localized symptoms should be
> >> evaluated by directed radiologic or endoscopic procedures. In
> >> addition, computerized tomography of the abdomen can identify a
> >> primary site in 10% to 35% of patients, and is frequently useful in
> >> identifying additional sites of metastatic disease.[1,2]
> >>
> >> Diagnostic Evaluation -- Generalized Approach
> >>
> >> Although overlap exists, subsequent clinical evaluation and treatment
> >> is dictated by the results of the initial light microscopic diagnosis.
> >> The four common histologic diagnoses are: adenocarcinoma (70%), poorly
> >> differentiated carcinoma (20%), squamous carcinoma (10%), and poorly
> >> differentiated neoplasm (5%).[3] Each of these four initial diagnoses
> >> requires slightly different clinical and pathologic evaluations.
> >>
> >> If the histologic diagnosis is adenocarcinoma or poorly differentiated
> >> carcinoma, additional diagnostic tests should be performed in certain
> >> subsets. Men with bone metastases should have serum prostate specific
> >> antigen (PSA) levels measured.[4] Women with clinical presentations
> >> compatible with metastatic breast cancer should have mammography
> >> performed. Men who are less than 50 years old with poorly
> >> differentiated carcinoma should have measurement of serum human
> >> chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP) levels. If
> >> the tumor is located in the mediastinum, retroperitoneum, or lymph
> >> nodes, measurement of these serum tumor markers should be considered
> >> in men older than 50 with poorly differentiated carcinoma, but the
> >> clinical utility in this group is still controversial.[4] In patients
> >> with squamous carcinoma, additional evaluation is often necessary.
> >> Metastatic squamous cancer is most commonly found in cervical lymph
> >> nodes. In these patients, a primary site in the head and neck region
> >> is most probable, and direct endoscopic visualization of the entire
> >> area (oropharynx, nasopharynx, hypopharynx, larynx) reveals a primary
> >> site in the majority. In patients who have squamous cancer metastatic
> >> to inguinal lymph nodes, careful evaluation of the perineal areas
> >> (cervix, vagina, vulva, anus, rectum, penis) is required.
> >>
> >> What Not To Do
> >>
> >> Extensive radiologic evaluation of asymptomatic areas is rarely useful
> >> in identifying a primary site, and often results in confusing or
> >> false-positive information.[5] Endoscopy of the gastrointestinal tract
> >> is also of low yield in asymptomatic patients, although small, occult
> >> primary sites are occasionally identified.[5] These expensive tests
> >> should therefore be avoided in asymptomatic patients. Similarly,
> >> routine tumor markers (CEA, CA19-9, CA125, CA27-29) are non-specific
> >> and should not be used to infer a primary site in this patient group.
> >> If no primary site is identified by the above clinical evaluation, the
> >> clinician should avoid the temptation to "guess" at a primary site
> >> based on a suggestive clinical presentation. Rather, the patient
> >> should be treated using guidelines for carcinoma of unknown primary
> >> site.
> >------------------------------------------------------------------------
> >This is an automatically-generated notice.  If you'd like to be removed
> >from the mailing list, please visit the Medicine-On-Line Discussion Forum
> >at <http://www.meds.com/con_faq.html>, or send an email message to:
> >majordomo@lists.meds.com
> >with the subject line blank and the body of the message containing the
> line:
> >unsubscribe mol-cancer your-email-address
> >where the phrase your-email-address is replaced with your actual email
> >address.
> >------------------------------------------------------------------------
> >
> 
> ------------------------------------------------------------------------
> This is an automatically-generated notice.  If you'd like to be removed
> from the mailing list, please visit the Medicine-On-Line Discussion Forum
> at <http://www.meds.com/con_faq.html>, or send an email message to:
> majordomo@lists.meds.com
> with the subject line blank and the body of the message containing the line:
> unsubscribe mol-cancer your-email-address
> where the phrase your-email-address is replaced with your actual email
> address.
> ------------------------------------------------------------------------
------------------------------------------------------------------------
This is an automatically-generated notice.  If you'd like to be removed
from the mailing list, please visit the Medicine-On-Line Discussion Forum
at <http://www.meds.com/con_faq.html>, or send an email message to:
majordomo@lists.meds.com
with the subject line blank and the body of the message containing the line:
unsubscribe mol-cancer your-email-address
where the phrase your-email-address is replaced with your actual email
address.
------------------------------------------------------------------------