Cancer of Unknown Primary Site Syndrome‐CUP Syndrome - Diagnostic and Therapeutical Dillemas

Pejčić, Ivica; Vrbić, Svetislav; Todorović, Mirjana; Petković, Ivan; Balic, M.; Stankovic, Ana R.

doi:10.2478/afmnai-2014-0010

Cited by 3 publications

(6 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The median age on presentation for both men and women in our study was 56 years which has varied in other series from 55 to 69 years, likewise, the male preponderance in our study (11:3) is very well consistent with that reported in previous studies. 6 Biological Features: Regardless of their heterogeneity, MUO have common biological features having the main characteristics as: Early dissemination in clinical absence of primary tumour; unpredictable metastatic pattern; aggressive biological and clinical behaviour. 6 Hypothetically, primary tumour remains of microscopic size or escapes clinical detection or disappears after the appearance of metastases.…”

Section: Figmentioning

confidence: 99%

“…6 Biological Features: Regardless of their heterogeneity, MUO have common biological features having the main characteristics as: Early dissemination in clinical absence of primary tumour; unpredictable metastatic pattern; aggressive biological and clinical behaviour. 6 Hypothetically, primary tumour remains of microscopic size or escapes clinical detection or disappears after the appearance of metastases.…”

Section: Figmentioning

confidence: 99%

“…2,3 Regardless of all available diagnostic procedures, attempts to detect primary tumour mainly remains futile and the primary site of origin is identified only in 13% of these patients. 6 A recent meta-analysis showed that, overall, FDG-PET/CT is able to detect 37% of primary tumours in MUO patients, with both sensitivity and specificity of 84%. 2,10 Hence, in near future, contrast enhanced PET-CT studies in MUO can be of greater use for establishing the diagnosis.…”

Section: Clinicalmentioning

confidence: 99%

See 2 more Smart Citations

Metastasis of Unknown Origin: An Enigma in Clinical Oncology

Dhull¹,

Atri²,

Kaushal³

et al. 2016

jebmh

View full text Add to dashboard Cite

INTRODUCTION Metastasis of unknown origin (MUO) represents a heterogeneous group of malignancies presenting with lymph nodes or distant metastases, for which diagnostic workup fails to identify the site of origin. Management of MUO with undetermined primary remains unclear because of the heterogeneous pathological condition and the treatment for such cases is still controversial. Various therapeutic regimens are present, but no clear-cut consensus has evolved. MUO on the whole carries a very poor prognosis. To assess the outcome of patients in a real-world situation, we retrospectively reviewed the database in our department to determine patterns of presentation and to analyse the response of various treatment modalities. MATERIAL AND METHODS The patients of metastasis of unknown origin who presented in the Department of Radiotherapy, PGIMS Rohtak from Jan 1st, 2008 to December 31st, 2010 were retrospectively analysed to determine patterns of presentation and to elucidate the outcome of various treatment modalities like radiation, surgery and chemotherapy. RESULTS Total 349 patients of metastasis of unknown origin were identified in the Department of Radiotherapy, PGIMS Rohtak, which constituted 4.9% of the total cancer patients. The median age at presentation was 56 years. Most of the patients presented in advanced stage (stage III-93% & stage IV-7%). In this retrospective analysis, the presenting site was lymph nodal in 68% and visceral in 32%. Out of total 349 patients of metastasis of unknown origin, 77 patients (22%) did not report for treatment after initial investigations. Out of the remaining 272 patients who took treatment, 185(68%) patients underwent radiotherapy and 137 patients (50%) received different chemotherapy protocols. 20% were given radical treatment and 58% were treated with palliative intent. Primary site was found in 13(5%) patients and were treated accordingly. CONCLUSION The overall prognosis in patients with MUO is generally very poor with a mean survival of 5-10 months. The most common site of presentation observed was cervical lymphadenopathy. Most of the patients presented in advanced stage and accordingly were treated with palliative intent. Evaluation of patients with metastasis of unknown origin should be structured to quickly identify treatable tumours or the need for palliation. Radiation therapy, chemotherapy and surgery were used alone or in combination to treat these patients to prolong survival and improve the quality of life.

show abstract

Section: Figmentioning

confidence: 99%

Section: Figmentioning

confidence: 99%

Section: Clinicalmentioning

confidence: 99%

See 1 more Smart Citation

Metastasis of Unknown Origin: An Enigma in Clinical Oncology

Dhull¹,

Atri²,

Kaushal³

et al. 2016

jebmh

View full text Add to dashboard Cite

show abstract

“…The term CUP is reserved for epithelial malignancies because other types of malignancies (such as melanomas, sarcomas, lymphomas) can usually be easily identified using immunohistochemistry [1, 2]. CUPs account for 3–5 % of all malignancies [3, 4] and in 24–36 % of patients with CUPs, the metastatic lymph node (LN) manifestations of the unknown primary cancer are in the head and neck (HN) region [5]. The primary tumour (PT) site in these patients is eventually identified in only 20–40 % of cases [6].…”

Section: Introductionmentioning

confidence: 99%

Impact of 3T multiparametric MRI and FDG-PET-CT in the evaluation of occult primary cancer with cervical node metastasis

et al. 2016

View full text Add to dashboard Cite

BackgroundThis study aimed to determine the ability of multimodal evaluation with multiparametric 3T-MRI (MPMRI) and positron emission tomography - computed tomography (PET/CT) to detect cancer of unknown primary origin (CUP) with neck lymph node (LN) metastasis.MethodsThe study group comprised 38 retrospectively analysed consecutive patients with LN metastasis in the head and neck (HN) region without known primary tumours (PTs). Statistical values of 3T-MRI and of FDG-PET/CT scans were evaluated.ResultsOf the 38 CUPs, conventional native T1-, T2-weighted and STIR sequences detected 6 PTs. Native sequences plus diffusion-weighted imaging (DWI) found 14-, and with fat suppression contrast-enhanced T1-weighted measurement as well as with the complex MPMRI found 15 primaries and with PET/CT 17 CUPs could be evaluated, respectively. The detection rates were 15.8, 36.8, 39.5, 39.5 and 44.7 % for conventional native MRI, native plus DWI, native with contrast-enhanced MRI (CE-MRI), for MPMRI, and for PET/CT, respectively. The overall detection rate proved by histology was 47.4 %. PET/CT provided the highest sensitivity (Sv: 94.4 %) but a lower specificity (Sp: 65.0 %), using MPMRI (Sv: 88.2 %) the specificity increased to 71.4 %. DWIincreased specificity of the native sequences (Sp: 76.2 %). Conventional native sequences plus DWI as well as 3T-MPMRI and PET/CT were same accurate (Acc: 79.0 %) and had similar likelihood ratio (LR: 3.42, 3.03 and 2.62) in detecting unknown PT sites.ConclusionsThe accuracy of FDG-PET/CT and MPMRI in case of CUP in finding the primary cancer in the neck regions is identical. While using PET/CT whole body information can be obtained in one examination. MPMRI shows the local soft tissue status more accurately. In cases of CUP PET/CT should be the first method of choice if it is available. MPMRI can clarify the exact primary tumor stage, and it can be advantageous in clarifying the prognostic factors, which is necessary in case of advanced tumor stage and when surgery is under consideration. In case low N stage is likely after the clinical examination and wait and see policy can be considered, MPMRI is recommended, and in this case the significance the of radiation free MPMRI is increasing.Electronic supplementary materialThe online version of this article (doi:10.1186/s40644-016-0097-x) contains supplementary material, which is available to authorized users.

show abstract

“…Those with primary detected lymph node involvement represent a specific group due to the fact that some of these subsets require specific treatment approaches and have the potential for an excellent outcome as squamous cell carcinoma involving cervical lymph nodes, women with adenocarcinoma involving only axillary lymph nodes, poorly di erentiated carcinoma with midline distribution (extragonadal germ cell), isolated inguinal adenopathy (squamous carcinoma) and patients with a single, small, potentially resectable tumor. Identification and treatment of these patients are of paramount importance, considering that the median overall survival varies in the range of one year [3][4][5][6]. Therefore, avoiding endless diagnostic studies and taking a rapid decision about treatment options is crucial.…”

mentioning

confidence: 99%

The impact of 18F-FDG PET/CT in the clinical management of patients with lymph node metastasis of unknown primary origin

Nikolova¹,

Hadzhiyska²,

Mladenov³

et al. 2021

neo

View full text Add to dashboard Cite

The aim of this study was to evaluate the diagnostic performance and the utility of F-18fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) in the clinical management of patients presenting with lymph node metastasis of undefined primary origin (CUP). A total of 53 patients (34 males, 19 females) with a diagnosis of lymph node metastasis according to the histopathology and/or conventional imaging were enrolled in this retrospective study. Patients were divided into four groups according to the initial location of their metastasisgroup 1, cervical lymph nodes (n = 39), group 2, axillary lymph nodes (n = 6), group 3, mediastinal lymph nodes (n = 2) and group 4, abdominal and pelvic lymph nodes (n = 6). The site of a probable primary malignancy suggested by PET/CT was confirmed by biopsy/further investigations or follow-up. 18F-FDG PET/CT accurately detected the primary carcinoma in 19 of 53 patients (36%), with head and neck cancer and lung carcinoma being the most common primary locations. The PET-CT scan results were negative for primary site localization in 13% of patients (false-negative), while 45% had true negative results, and 6% displayed false-positive results. Additional distant metastatic foci were identified in 21 of all patients (40%). The overall sensitivity, specificity, and accuracy rates of the study were identified as 73%, 89%, and 81%, respectively; in the group with cervical lymph node metastasis sensitivity 70% and specificity 84%. To conclude, 18F-FDG PET/CT is a sensitive and selective procedure for detecting unknown primary tumors, especially in the clinical setting of cervical lymph node metastasis and its use should be encouraged earlier in pre-treatment phase of CUP-patients, leading to higher detection of probable primary sites, guiding subsequent biopsy, and more accurate detection of distant metastases in a single examination.

show abstract

Cancer of Unknown Primary Site Syndrome‐CUP Syndrome - Diagnostic and Therapeutical Dillemas

Cited by 3 publications

References 19 publications

Metastasis of Unknown Origin: An Enigma in Clinical Oncology

Metastasis of Unknown Origin: An Enigma in Clinical Oncology

Impact of 3T multiparametric MRI and FDG-PET-CT in the evaluation of occult primary cancer with cervical node metastasis

The impact of 18F-FDG PET/CT in the clinical management of patients with lymph node metastasis of unknown primary origin

Contact Info

Product

Resources

About