CA: A Cancer Journal for Clinicians, Vol 42, Issue 2 96-115, Copyright © 1992 by American Cancer Society
Tumors of unknown origin
F. A. Greco and J. D. Hainsworth
Vanderbilt University Medical Center, Nashville, Tennessee.
The recognition of subsets of very treatable patients within the large
heterogeneous population of carcinomas of unknown primary site represents
an advance in the management of these patients. These patients with
responsive tumors can be defined with appropriate clinical and pathologic
evaluation. A summary of the subsets and an outline of the evaluation
necessary for their identification is illustrated in Table 5. A therapeutic
trial remains the only method to determine if patients have responsive
tumors, and several patients who do not conform to a defined subset do
respond to cisplatin-based chemotherapy. Unfortunately, there is still a
large group of patients with relatively insensitive tumors. Improved
therapy for these patients will probably await advances in the treatment of
non-small cell lung cancer, pancreatic cancer, and the other
gastrointestinal cancers, since the majority of insensitive carcinomas
probably arise from these occult primary sites. We have a registry at
Vanderbilt and are attempting to register patients of other physicians
around the country. We request pathology material and clinical summaries
and follow-up data on all these patients. An unstained slide bank has also
been established so that special stains developed in the future may be
rapidly evaluated. These data may eventually enable us to better determine
the frequency and spectrum of these neoplasms and may allow for more
specific diagnoses and therapy.
