Cancer of unknown primary: clinicopathologic correlations

Cancer of unknown primary origin (CUP) accounts for 5–10% of all malignant tumors at presentation and remains the death certificate diagnosis in 0.5–5% of patients. We investigated CUP patients whose primary site remained unknown throughout the entire clinical course. We reviewed 9,436 consecutive a...

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Published in:APMIS : acta pathologica, microbiologica et immunologica Scandinavica microbiologica et immunologica Scandinavica, 2003-12, Vol.111 (12), p.1089-1094
Main Authors: BLASZYK, HAGEN, HARTMANN, ARNDT, BJÖRNSSON, JOHANNES
Format: Article
Language:English
Subjects:
Adenocarcinoma - secondary
Adenocarcinoma - therapy
Adult
Aged
Aged, 80 and over
Autopsy
Biliary Tract - pathology
Biliary Tract Neoplasms - diagnosis
Biological and medical sciences
Cancer
Carcinoma, Neuroendocrine - secondary
Carcinoma, Neuroendocrine - therapy
Carcinoma, Squamous Cell - secondary
Carcinoma, Squamous Cell - therapy
Cohort Studies
Female
Fundamental and applied biological sciences. Psychology
Gastrointestinal Neoplasms - diagnosis
Gastrointestinal Tract - pathology
Humans
Infectious diseases
Lung - pathology
Lung Neoplasms - diagnosis
Male
Medical sciences
Microbiology
Middle Aged
Neoplasms, Unknown Primary - mortality
Neoplasms, Unknown Primary - pathology
Neoplasms, Unknown Primary - therapy
Pancreas - pathology
Pancreatic Neoplasms - diagnosis
smoking
Tumors
unknown primary
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Summary:Cancer of unknown primary origin (CUP) accounts for 5–10% of all malignant tumors at presentation and remains the death certificate diagnosis in 0.5–5% of patients. We investigated CUP patients whose primary site remained unknown throughout the entire clinical course. We reviewed 9,436 consecutive autopsies performed between 1984 and 1999 at the Mayo Clinic, matched with 177,167 cancer patients treated in the same time period. Sixty‐four patients who died of CUP underwent postmortem examination. Antemortem pathologic diagnoses were obtained in 57 patients, agreed with postmortem diagnoses in 98%, and included adenocarcinoma (n=44), undifferentiated carcinoma (n=7), squamous cell carcinoma (n=3), and others (n=3). Autopsy located the primary site in 35 patients (55%). Common primary sites were lung (n=8), the pancreaticobiliary (n=13) and GI tracts (n=9). Of 43 patients evaluated for tumor‐specific therapy, only six received no further oncologic treatment and untreated patients survived a median of 57 (range 10–280) days, compared with 225 (range 19–1,129) days for patients treated with chemotherapy and/or radiotherapy (n=37). Our findings show that (1) autopsy studies provide a valuable tool for quality control in the setting of CUP, and (2) treated patients have a small but significant survival benefit.
ISSN:0903-4641
1600-0463
DOI:10.1111/j.1600-0463.2003.apm1111203.x