MANAGEMENT OF SPECIFIC TREATABLE SUBSETS
Because patients with cancer of unknown primary site have advanced disease, therapeutic nihilism has been common. However, several subsets of patients can benefit from specific treatment, and they can be identified on the basis of clinical and pathologic features. These patients are important to recognize and treat appropriately because some individuals in each group have the potential for long-term survival.
SPECIFIC PATIENT SUBSETS AND RECOMMENDED TREATMENT
|SUBSET-IDENTIFYING FEATURES||TREATMENT RECOMMENDATIONS|
|Adenocarcinoma||Women, isolated axillary adenopathy||Treat as stage II breast cancer|
|Adenocarcinoma, poorly differentiated carcinoma||Women, peritoneal carcinomatosis
|Treat as stage III ovarian cancer|
|Adenocarcinoma||Men, elevated PSA or blastic bone metastases||Treat as advanced prostate cancer|
|Adenocarcinoma, poorly differentiated carcinoma||Single metastatic lesion||Definitive local therapy (resection or radiation therapy [or both]) with or without chemotherapy|
|Adenocarcinoma||Colon cancer profile||Treat as metastatic colorectal cancer|
|Squamous||Cervical adenopathy||Treat as locally advanced head or neck cancer|
|Squamous||Inguinal adenopathy||Definitive local therapy (node dissection with or without radiation therapy) with or without chemotherapy|
|Poorly differentiated carcinoma||Young men with midline tumour or elevated hCG or AFP||Treat as extragonadal germ cell tumour|
|Neuroendocrine carcinoma, poorly differentiated||Diverse clinical presentations||Treat as advanced stage small cell lung cancer|
|Neuroendocrine carcinoma, well differentiated||Usually liver metastases||Treat as metastatic carcinoid tumour|
AFP = α-fetoprotein; hCG = human chorionic gonadotropin; PSA = prostate-specific antigen.