Cancer of unknown primary location

Question 1

If single inguinal lymph node with squamous cell, where do you look / what to do?

Answer 1

do anoscopy and examine genitalia (including cervix in females)

Question 2

If young male with bulky midline retroperitoneal or mediastinal lymphadenopathy, what to do?

Answer 2

treat as germ cell tumor with platinium based chemotherapy

Question 3

If adenocarcinoma below the diaphragm, what to do

Answer 3

treat as a Gi malignancy

Question 4

If female with single axillary lymph node with adenocarcinoma, what to do?

Answer 4

do breast MRI and treat as a primary breast cancer even if negative

if MRI is negative.

get immunological staining for HER2 expression and ER and PR.

need to get left axillary dissection.

then either do mastectomy breast and axillary radiation.

Question 5

if cancer of unknown primary or in a single cervical lymph node?

Answer 5

treat as a head and neck cancer

Question 6

If female with adenocarcinoma with abdominal carcinomatosis and ascites?

Answer 6

treat as ovarian cancer

Question 7

majority of carcinoma of unknown origin are:

Answer 7

adenocarcinoma (66%)

second most is: poorly differentiated

third: all others.

Question 8

female with adenocarcinoma in the axillary LN?

Answer 8

treat as a breast cancer diagnosis
do mammogram +/- MRI
ER/PR receptors

mastectomy, radiation chemotherapy

Question 9

male with adenocarcinoma with bony involvement

Answer 9

pursue a prostate cancer diagnosis

ask for urinary symptoms do PSA and rectal exam

Question 10

poorly differentiated cancer in young males?

Answer 10

pursue a germ cell tumor diagnosis

do an alpha fetoprotein and beta hcG

platinum based chemotherapy if positive

Question 11

squamous cell cancer in lower cervical lymph nodes positive

Answer 11

pursue a lung cancer diagnosis

get upper panendoscopy - laryngoscopy, bronchoscopy, and endoscopy

Question 12

squamous cell cancer in cervical lymph node

Answer 12

(NOT lower)

pursue a head and neck diagnosis.

Question 13

most common place of presentation of carcinoma of unknown origin:

Answer 13

lymph node.

Question 14

abdominal cancer of unknown origin with adenocarcinoma treat with

Answer 14

5FU leucovorin, oxaliplatin (FOLFOX)
OR 
5FU leucovorin and irinotecan (FOLFIRI)
OR
5FU, leucovorin, irinotecan or oxaliplatin (FOLFIRINOX)