Carcinoma with Unknown Primary
Published Date: 19th July 2016
Publication Authors: , Marshall E, Thind R
Abstract
Widespread metastatic disease with no obvious primary on initial investigations is a diagnostic challenge often encountered by radiologists. Carcinoma of unknown primary origin (CUP) forms a heterogeneous group of cancers constituting approximately 3-5% of new cancers and amongst the top 10 causes of cancer-related deaths worldwide. A radiologist is often the first physician to identify a potential CUP, orchestrating further invasive or non-invasive investigations. Many tests are often recommended and performed resulting in a significant financial burden on health care services and contributing to morbidity of these patients without prolonging survival. In 2010, guidelines were published by the National Institute of Clinical Excellence (NICE, United Kingdom), to develop a patient-centred approach to the management of this group of patients. We (1) briefly discuss the pathophysiology of CUP; (2) highlight salient points in the NICE guidelines relevant to radiologists with suitable examples from our 1-year experience of a multidisciplinary team approach involving a dedicated radiologist; (3) discuss current and emerging modalities of imaging used for investigations; (4) emphasize favourable and unfavourable imaging traits used in the selection of patients who may respond to tailor-made treatment regimes that are increasingly favoured in the treatment of patients with CUP; (5) share examples of oversights especially when a benign cause is eventually found. Despite recent advances in diagnostic modalities, the prognosis of patients with widespread metastatic disease at presentation with unapparent primary remains poor. Therefore awareness of the limitations of investigations and treatment together with a holistic approach is crucial for every radiologist.
Aurangabadkar, A; Thind, R; Marshall, E. (2011). Management of carcinoma with unknown primary: what does a radiologist need to know? Cancer imaging. 11 (A), S177.
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