Urologische Bedeutung

Zusammenfassung

Metastasen eines unbekannten Primärtumors CUP treten in 0,4 bis 7 Prozent aller Tumoren auf. Umfangreiche und kostspielige Diagnostik führt nur selten zur Diagnose des Primarius und hat keinen Einfluss auf die mittlere Überlebenszeit. Für die meisten Patienten kommt lediglich eine palliative Behandlung in Betracht. Es gilt, die wenigen behandelbaren Primärtumoren zu erkennen (Brust, Keimzell, NHL). Empirische Behandlungsmethoden (Chemotherapie, Radiatio, Radikaloperationen) sind aufgrund des hohen Risikos im Vergleich zu mäßigem Erfolg nicht empfehlenswert. Für Arzt und Patient entsteht eine unbefriedigende Situation durch Minimieren der Diagnostik bei fehlenden Behandlungsmöglichkeiten.

Abstract

Cancer of unknown primary site (CUP) occurs in 0.4 % - 7 % of all tumors. Extensive and costly diagnostic protocolls only rarely lead to identification of the primary tumor and do not affect the mean actuarial survival. Merely palliative treatment is feasible for most patients. The few primary tumors that can be treated must be identified (breast, germinal cell, non-Hodgkin lymphoma). Empirical treatment methods (chemotherapy, radiation, radical operations) are inappropriate owing to the high risk in relation to poor success. An unsatisfactory situation ensues for both doctors and patients when diagnostics are minimized because treatment is unavailable.

Key words:

CUP - Retroperitoneal neoplasm - Unknown origin - Diagnostic techniques

Literatur

• 1 Abbruzzese J L, Lenzi R, Raber M N, Pathak S, Frost P. The biology of unknown primary tumors.  Semin in Oncol. 1993;  20 Nr. 3 238-243
• 2 Abbruzzese J L, Abbruzzese M C, Lenzi R, Hess K R, Raber M N. Analysis of a diagnostic strategy for patients with suspected tumors of unknown origin.  J Clin Oncol. 1995;  13 Nr. 8 2094-2103
• 3 Arnold A, Cossman J, Bakhshi A, Jaffe E S, Waldmann T A, Korsmeyer S J. Immunoglobulin-gene rearrangements as unique clonal markers in human lymphoid neoplasms.  NEJM. 1983;  309 1593-1599
• 4 Bosl G J, Dmitrovsky E, Reuter V, Samaniego F, Murty V VS, Chaganti R SK. A specific karyotypic abnormality in germ cell tumors.  Proc Am Soc Clin Oncol. 1989;  8 131 abstract
• 5 Diggs C H. Cancer of unknown primary site.  Postgraduate Med. 1989;  86 Nr. 2 186-191
• 6 Gatter K C, Alcock C, Heryet A, Mason D Y. Clinical importance of analysing malignant tumors of uncertain origin with immunohistochemical techniques.  Lancet. 1985;  1 1302-1305
• 7 Gentile P S, Carloss H W, Huang T Y, Lam W K. Disseminated prostate carcinoma simulating primary lung cancer.  Cancer. 1988;  62 711-715
• 8 Greco F A, Vaughn W K, Hainsworth J D. Advanced poorly differentiated carcinoma of unknown primary site: recognition of treatable Syndrome.  Ann Intern Med. 1986;  104 547-553
• 9 Greco F A, Hainsworth J D. Poorly differentiated carcinoma or adenocarcinoma of unknown primary site: long term results with cisplatin-based chemotherapy.  Semin Oncol. 1994;  21 Suppl 12 77-82
• 10 Greco F A, Hainsworth J D. The evolving role of paclitaxel for patients with carcinoma of unknown primary site.  Semin Oncol. 1999;  26 Suppl 2 129-133
• 11 Grosbach A B. Carcinoma of unknown primary site.  Arch Intern Med. 1982;  142 357-359
• 12 Guarschi A, Keane T J, Elhakim T. Metastatic inguinal nodes from an unknown primary neoplasm: a review of 56 cases.  Cancer. 1987;  59 572-577
• 13 Hainsworth J D, Johnson D H, Greco F A. Cisplatin-based chemotherapy in the treatment of poorly differentiated adenocarcinoma of unknown primary site: results of a 12-year experience.  J Clin Oncol. 1992;  10 912-922
• 14 Hainsworth J D, Greco F A. Treatment of patients with cancer of unknown primary site.  NEJM. 1993;  329 Nr 4 257-263
• 15 Hainsworth J D, Greco F A. Poorly differentiated carcinoma and poorly differentiated adenocarcinoma of unknown primary site.  Semin Oncol. 1993;  20 Nr 3 279-286
• 16 Jesse R H, Neff L E. Metastatic carcinoma in cervical nodes with an unknown primary site.  Am J Surg. 1996;  112 547-553
• 17 Jordan III W E, Shildt R A. Adenocarcinoma of unknown primary site.  Cancer. 1985;  55 857-860
• 18 Kafagiri H, Takahashi M, Inagaki J, Sugiura H, Ito S, Iwata H. Determining the site of the primary cancer in patients with skeletal metastasis of unknown origin.  Cancer. 1999;  86 Nr 3 533-537
• 19 Karsell P R, Sheedy II P F, O'Connell M J. Computed tomography in search of cancer of unknown origin.  JAMA. 1982;  248 Nr 3 340-343
• 20 König M, Shadouh S, Boeminghaus F. Das kleinzellige Harnblasenkarzinom.  Akt Urol. 1997;  27 422-425
• 21 Kole A C, Nieweg O E, Pruim J, Hoekstra H J, Koops H S, Roodenburg J LN, Vaalburg W, Vermey W. Detection of unknown occult primary tumors using positron emission tomography.  Cancer. 1998;  82 Nr 6 1160-1166
• 22 Mackay B, Ordonez N G. The role of the pathologist in the evaluation of poorly differentiated tumors.  Semin in Oncol. 1982;  9 Nr 4 396-415
• 23 Muir C. Cancer of unknown primary site.  Cancer. 1995;  suppl 75 Nr 1 353-356
• 24 Nystrom J S, Weiner J M, Heffelfinger-Juttner J, Irwin L E, Bateman J RT, Wolf R M. Metastatic and histologic presentations in unknown primary cancer.  Semin in Oncol. 1977;  4 53-58
• 25 Nystrom J S, Weiner J M, Wolf R M, Bateman J R, Viola M V. Identifying the primary site in metastatic cancer of unknown origin.  JAMA. 1979;  241 Nr 4 381-383
• 26 Ransom D T, Patel S R, Keeney G L, Malkasian G D, Edmonson J H. Papillary serous carcinoma in the peritoneum: a review of 33 cases treated with platin-based chemotherapy.  Cancer. 1990;  66 1091-1094
• 27 Ringenberg S, Doll D C, Yarbo J W, Perry M C. Tumors of unknown origin in the bone.  Arch Intern Med. 1986;  146 2027-2028
• 28 Robert N J, Garnick M B, Frei III E. Cancers of unknown origin: Current approaches and future perspectives.  Semin in Oncol. 1982;  9 Nr 4 526-531
• 29 Schapira D V, Jarrett A R. The need to consider survival, outcome and expense when evaluating and treating patients with unknown primary carcinoma.  Arch Inter Med. 1995;  155 2050-2054
• 30 Schlag P M, Hunerbein M. Cancer of unknown primary.  Ann Chir Gynaecol. 1994;  83 8-12
• 31 Silverman C, Marks J E. Metastastic cancer of unknown origin: Epidermoid and undifferentiated carcinomas.  Semin in Oncol. 1982;  9 Nr 4 435-441
• 32 Snyder R D, Mavligit G M, Valdivieso M. Adenocarcinoma of unknown primary site: A clinico-pathological study.  Med Pediatr Oncol. 1979;  6 289-294
• 33 Solomon E, Borrow J, Goddard A D. Chromosome aberrations und cancer.  Science. 1991;  254 1153-1160
• 34 Sporn J R, Greenberg B R. Empiric chemotherapy in patients with carcinoma of unknown primary site.  Am J Med. 1990;  88 49-55
• 35 Stewart J F, Tattersall M H, Woods R L. Unknown primary adenocarcinoma: Incidence of over investigation and natural history.  BMJ. 1979;  1 1530-1533
• 36 Turc-Carel C, Philip I, Berger M P, Philip T, Lenoir G M. Chromosomal translocations in Ewing's sarcoma.  NEJM. 1983;  309 497-498
• 37 van der Gaast A, Verweij J, Henzen-Logmans S C, Rodenberg C J, Stoter G. Carcinoma of unknown primary: Identification of a treatable subset.  Ann Oncol. 1990;  1 119-122
• 38 Whang-Peng J, Triche T J, Knutsen T, Miser J, Douglass E C, Israel M A. Chromosome translocation in peripheral neuroepithelioma.  NEJM. 1984;  311 584-585
• 39 Woods R L, Fox M B, Tattersall M HN, Levi J A, Brodie G N. Metastatic adenocarcinomas of unknown primary site.  NEJM. 1980;  303 Nr 2 87-89