Cancers of Unknown Primary Site
These are cancers that present with metastasis to other areas of the body and for which the site of origin is unknown. Most these patients undergo an extensive work up, however we are left with an advanced cancer that may be spread to many organs at the time of diagnosis and not knowing where the cancer originated from. In some cases, the primary site can not be detected even in postmortem examination. Cancers of Unknown primary sites, account for up to 10% of all cancer patients. Average age of patients with this condition is 56-60 years.
Signs and Symptoms
Signs and symptoms will depend on the way these cancers will present themselves. Patients may present with any of the following problems:
Lung Metastasis
Brain metastasis
Bone metastasis
High Calcium level
Pain
Spinal cord compression
Enlarged lymph glands
Establishing Diagnosis
When the diagnosis is suspected, patients have to be referred to a medical oncologist and be examined carefully. A variety of tests may have to be performed to determine the extent of the cancer, as well as the potential primary site. If a primary cancer site is determined, then the cancer will not be classified as unknown primary cancer. Normal work up includes, chest X-ray, CT scan of chest, abdomen, pelvis and a Bone Scan. Blood tests for tumor markers may be performed. Next step is taking a biopsy and evaluation of the tissue sample.
Treatment
This condition is basically treated with chemotherapy, using a variety of drugs that have proven to be effective under these circumstances. Most effective chemotherapy drugs that are used to treat this condition are:VP-16, Carboplatinum, Cisplatinum, Ifosfamide. Chemotherapy is normally given every three to four weeks, for a period of 3 to 6 months. Common treatment regimens are variants of BEP and VIP regimens. The looks of cancer under microscope is the guide to choosing an effective chemotherapy regimen.
Survival
Survival of patients with this cancer depends on their response to treatment. In majority of patients, the disease will relapse within a year and becomes resistant to treatment. Survival could vary from months to years, depending on the extent of cancer, overall condition of the patient as well as their response to treatments and the duration of their response. Radiation therapy may be helpful in managing painful or symptomatic areas, where the cancer has spread to. If patients experience pain, different pain medications could be used to alleviate the pain. For patients with advanced disease, where most treatments have failed, one could consider assistance from hospice.
