Metastatic Cancer With Unknown Primary Site Clinical Presentation
- Author: Winston W Tan, MD, FACP; Chief Editor: Wafik S El-Deiry, MD, PhD more...
Because most patients with malignant neoplasms of unknown origin have fairly advanced-stage disease, the constitutional symptoms of malaise, weakness, fatigue, and weight loss are present in nearly all patients.
The clinical presentation of cancer of unknown primary origin is extremely variable, and depends on the extent and type of organ involvement. Most patients present with multiple areas of involvement in multiple visceral sites, the most common being lung, bone, lymph nodes, and liver. A detailed physical examination should be conducted, and should include head and neck, rectal, testicular, pelvic, and breast examinations.
Patients have early dissemination of their cancer without symptoms at the primary site. Nevertheless, clinical manifestations may suggest the primary site, as follows:
- Ascites should lead to evaluation for a gastrointestinal or an ovarian primary.
- Cervical lymphadenopathy should lead to a thorough otolaryngologic examination
- Apparent bone metastasis should lead to evaluation for prostate, breast, lung, renal, or thyroid primary
- A testicular mass should lead to measurement of tumor markers such as beta–human chorionic gonadotropin (beta-HCG) and alpha-fetoprotein (AFP)
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|Primary Marker||Primary Tumor Type||Additional Markers|
|CK7- /CK 20 +||Colorectal cancer and merkel cell carcinoma||CEA and CDX-2 (for GI malignancy)|
|CK 7 +/CK 20 -||Lung,breast, thyroid, endometrial, cervical, pancreas, and cholangiocarcinoma||TTF-1 (lung, thyroid)|
ER, PR (breast)
CK- 19 (pancreas)
|Ck+7/ CK 20+||Urothelial, ovarian, pancreas, cholangiocarcinoma||Urothelin (genitourinary) |
WT-1 (ovarian, mesothelial)
|CK = cytokeratin; CEA = carcinoembryonic antigen; TTF1 = thyroid transcription factor 1; ER = estrogen receptor; PR = progesterone receptor; GCDFP-15 = gross cystic disease fluid protein–15; WT-1 = Wilms tumor gene 1; PSA = prostate specific antigen|