occult primary malignancy

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occult primary malignancy

Occult cancer, unknown primary A malignancy of unknown 1º site or origin that is symptomless, which first manifests itself as metastases or secondary–paraneoplastic phenomena, and usually has a poor prognosis; OPMs are problematic as appropriate therapy requires that the primary malignancy be eradicated, and many remain obscure despite aggressive diagnostic work-up; certain malignancies metastasize to certain sites with greater than expected frequency; in OPMs affecting the brain, the primary arises in the lungs in up to 85% Treatment Up to 30% of Pts with metastases from an occult primary adenoCA may respond to chemotherapy–mitomycin C, adriamycin, vincristine; poor response is more common in ♂ and in Pts with liver and/or infradiaphragmatic metastases
Occult primary malignancies
Bone Breast, bronchus, prostate, thyroid, kidney
CNS Breast, bronchus, kidney, colon
Head & neck Oropharynx, nasopharynx–most are squamous cell carcinoma;  also adenocarcinoma, melanoma, rhabdomyosarcoma, oat cell, salivary  gland, thyroid carcinomas
Liver CA of stomach, colon, breast, pancreas, or bronchus
Lung Breast, colon, kidney, melanoma, sarcoma, stomach, testis, thyroid
Lymph nodes
• Cervix  Naso– and oropharynx, thyroid, larynx, lymphoma
• Supraclavicular  Bronchi, breast, stomach, esophagus, pancreas, colorectal,
lymphoma
• Axillary  Breast, melanoma, lymphoma
• Inguinal  Urogenital tract, anus, melanoma, lymphoma
Ovary Stomach, colon
Serosal surfaces Bronchi, breast, ovary, lymphoma
Skin Melanoma, breast, bronchus, stomach, kidney