Metastatic Cancer With Unknown Primary Site Clinical Presentation

Updated: May 07, 2019
  • Author: Winston W Tan, MD, FACP; Chief Editor: Wafik S El-Deiry, MD, PhD  more...
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Presentation

History

The clinical presentation of cancer of unknown primary origin is extremely variable, and depends on the extent and type of organ involvement, However, because most of these patients have fairly advanced-stage disease, they typically present with the constitutional symptoms of malaise, weakness, fatigue, and weight loss.

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Physical Examination

Most patients with cancer of unknown primary origin 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.

  • An axillary mass in a woman should lead to evaluation for breast cancer [5, 6]

  • Cervical lymphadenopathy should lead to a thorough otolaryngologic examination [7]

  • Signs consistent with brain metastasis should lead to a search for a lungbreast, or kidney primary

  • 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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