title: Management of patients with cancer of unknown primary site.
abstract: Cancer of unknown primary site represents approximately 3% to 5% of all new cancer diagnoses. Adenocarcinomas account for 60% of all unknown primary cancers and poorly differentiated carcinomas or adenocarcinomas, for 30%. Historically, the prognosis for most patients with unknown primary tumors has been poor, with survival often less than 6 months from diagnosis. Recent advances in diagnostic techniques, including immunocytochemical and molecular genetic methods, have increased the probability of identifying a likely underlying tumor type. Based on clinical and pathologic features, approximately 40% of patients can be categorized within subsets for which specific treatment has been defined. Empiric therapy is an option for the remaining 60% of patients. In these patients, favorable prognostic factors for treatment response include tumor location in lymph nodes, fewer sites of metastases, younger age, and poorly differentiated carcinoma histology. Although experience remains limited, the incorporation of a taxane into empiric regimens appears to improve response rates and survival. A recent study of paclitaxel (Taxol), carboplatin (Paraplatin), and etoposide in 55 patients with cancer of unknown primary site reported an overall response rate of 47% and a median overall survival of 13.4 months. Investigations continue to explore new diagnostic techniques and novel therapeutic approaches.
authors.affiliation: Sarah Cannon Cancer Center, Centennial Medical Center, Nashville, Tennessee, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Hainsworth
authors.forename: F A
authors.initials: FA
authors.lastname: Greco
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000188:drug therapy* / Q000556:secondary; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001952:Bridged-Ring Compounds / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D002277:Carcinoma / Q000175:diagnosis / Q000188:drug therapy* / Q000556:secondary; D005047:Etoposide / Q000008:administration & dosage; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D017239:Paclitaxel / Q000008:administration & dosage; D011379:Prognosis; D015996:Survival Rate; D043823:Taxoids
chemical_list: D000970:Antineoplastic Agents; D001952:Bridged-Ring Compounds; D043823:Taxoids; C080625:taxane; D005047:Etoposide; D016190:Carboplatin; D017239:Paclitaxel