Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

HPIM Onco > 120e Carcinoma of Unknown Primary > Flashcards

120e Carcinoma of Unknown Primary Flashcards

1
Q

Biopsy-proven malignancy for which the anatomic site of origin remains unidentified after an intensive search

A

Carcinoma of unknown primary (CUP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

One hypothesis for CUP

A

Primary tumor either regresses after seeding the metastasis or remains so small that it is not detected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CUP biology

A

Studies have not been successful.

  1. Abnormalities in chromosomes 1 and 12
  2. Aneuploidy
  3. Overexpression of genes (Ras, bcl-2, her-2 and p53
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

2 goals in the initial CUP evaluation

A
  1. Search for the primary tumor based on pathologic evaluation of metastases
  2. Determine the extent of disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

T or F: Most tumor markers when elevated are specific and will be helpful in determining the primary tumor site.

CEA, CA-125, CA19-9, CA 15-3

A

False

Are nonspecific and NOT helpful in determining the primary tumor site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Standard of care on imaging for CUP

A

If no contraindications:

Baseline CT with IV contrast of CHEST, ABDOMEN, PELVIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Test that should be performed in all women who present with metastatic adenocarcinoma and presenting with isolated axillary lymphadenopathy

A

Mammography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If your female patient with CUP tested negative for mammography and ultrasound, what is the next step?

A

MRI of breast

Negative MRI: predicts low tumor yield at mastectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Conventional workup for squamous cell carcinoma and cervical CUP (neck lymphadenopathy with no known primary tumor)

A
  1. CT scan or MRI
  2. Indirect and direct laryngocscopy
  3. Bronchoscopy
  4. Upper endoscopy
  5. Ipsilateral (or bilateral) staging tonsillectomy has been RECOMMENDED for these pt
  6. 18-Fluorodeoxyglucose positron emission tomography scan are useful
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

T or F: PET is not routinely recommended

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

T or F: Invasive studies, including upper endoscopy, colonoscopy, and bronchoscopy should be done in all patients to determine the primary cause in CUP.

A

False

Should be limited to SYMPTOMATIC patients or those with labs, imaging or pathologic abnormalities suggesting high yield in these procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

T or F: Detailed pathologic examination of the most accessible biopsied tissue specimen is mandatory in CUP patients using H&E stains and immunohistochemical tests

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cancers that rarely present as CUP

A
  1. Prostate Ca

2. Thyroid Ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cytokeratin markers used in adenocarcinoma of unknown primary

A

CK7 and CK20

See Figure 120e-1, p.120e-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Cytokeratin marker found in tumors of the lung, ovary, endometrium, breast and upper GI tract including pancreaticobiliary cancers

A

CK7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Cytokeratin marker normally expressed in GI epithelium, urothelium and Merkel cells

A

CK20

17
Q

Thyroid transcription factor 1 (TTF-1) nuclear staining is typically positive in what type of cancers?

A

Lung cancer

Thyroid cancer

18
Q

Markers used to diagnose lesions of urothelial origin

A

UROIII
High molecular weight cytokeratin
Thrombomodulin
CK20

19
Q

Product of homeobox gene necessary for intestinal organogenesis often used to aid in diagnosis of GI adenocarcinomas

A

CDX-2 transcription factor

20
Q

Phenotypes very suggestive of lung and lower GI cancer profiles

A

LUNG CA: TTF-1/CK7+

Lower GI CA: CK20+/CDX-2+/CK7-

21
Q

Immunohistochemical stains for diagnosis of CUP

A

See Table 120e-2

22
Q

Median survival duration of most patients with disseminated CUP

A

6-10 months

23
Q

Primary treatment modality in most patients with disseminated disease

A

Systemic chemotherapy

24
Q

Prognostic factors in treatment of CUP

A
  1. Performance status
  2. Site and number of metastases
  3. Response to chemotherapy
  4. Serum LDH
25
Q

Management of women with carcinoma/adenoCA with Isolated Axillary Adenopathy

A

Treat for Stage II or III breast CA based on pathologic findings

26
Q

Factors to consider on what therapy to use: chemotherapy and/or hormonal therapy

A
  1. Age of patient
  2. Nodal disease bulk
  3. Hormone receptor status
27
Q

Term used to describe CUP with carcinomatosis with the pathologic and laboratory (elevated CA-125 antigen) characteristics of ovarian cancer but no ovarian primary tumor identified on transvaginal sonography or laparotomy

A

Primary Peritoneal Papillary Serous Carcinoma (PPSC)

28
Q

Management for patients with PPSC

A

Candidates for cytoreductive surgery then

Adjuvant taxane- and platinum-based chemo

29
Q

Colon cancer profile in IHC

A

CDX-2+/CK20+/CK7-

30
Q

If your male patient with CUP presented with metastases only on the bones, and PSA is not elevated, what is the next step?

A

Chemotherapy or Radiotherapy as indicated

31
Q

In a patient with CUP presenting with solitary site of metastasis, and the tumor is unresectable, what is the next step?

A

Chemotherapy, Radiotherapy OR chemoradiotherapy depending on location of tumor

32
Q

In a patient with CUP and IHC suggests possible peritoneal carcinoma, probably PRIMARY peritoneal cancer. What is your next step?

A

Treat as OVARIAN cancer

33
Q

Patient with CUP, presented with disseminated cancer, 2 or more sites involved. What is your next step?

A

Chemotherapy IF good performance status

34
Q

For a patient suspected with squamous cell CUP, presenting with metastatic cervical adenopathy, what is your next step?

A
  1. Triple endoscopy
  2. Consider tonsillectomy
  3. CT scan of neck and chest
    PET is optional

See Figure 120e-3 for the algorithm

35
Q

Men with poorly differentiated or undifferentiated carcinoma that presents as midline adenopathy should be evaluated for what malignancy?

A

Extragonadal germ cell malignancy

If older pt and smokers: suspect lung or head-and-neck cancer profile

36
Q

Neuroendocrine carcinoma treatment decisions are based on symptoms and tumor bulk. Often they are treated with this hormone for symptoms such as diarrhea, flushing, and nausea.

A

Somatostatin analogues

37
Q

Management for patients with early-stage squamous cell CA involving the cervical lymph nodes

A

Candidates for node dissection and radiation therapy

38
Q

Chemotherapeutic regimens for CUP presenting as metastatic disease

A
  1. Paclitaxel-Carboplatin
  2. Gemcitabine-Cisplatin
  3. Gemcitabine-Oxaliplatin
  4. Irinotecan and fluoropyrimidine-based therapies

HPIM Onco (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions