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A. Diagnostic Approachnavigator

  1. Scenerio
    1. Patient presents with mass, or bone pain, or other symptom and tumor is most likely
    2. Biopsy is usually planned, but may be (far) easier if primary site is determined
    3. In addition, type of tumor does impact on therapy and prognosis
  2. Careful History and Physical
  3. Pelvic and Rectal examinations
  4. Routine laboratory evaluations - include liver function tests
  5. Chest Radiograph
  6. Abdominal CT Scan
  7. Whole-body positron emission scanning can detect occult malignancy prior to symptoms [2]
  8. Biopsy for Tissue
  9. Autopsy diagnoses of malignant neoplasms frequently disagree with clinical diagnoses [3]

B. Biopsy Resultsnavigator

  1. Adenocarcinoma (60%)
    1. Specific subgroup (6%) - especially breast, ovary, prostate (potentiially treatable)
    2. No specific subgroup (54%)
  2. Poorly differentiated (adeno)carcinoma (30%)
    1. No further differentiation (25%)
    2. Lymphoma, Melanoma, Sarcoma (3%)
    3. Other specific Carcinoma (1%) including small cell lung carcinoma
  3. Non-Carcinoma, Poorly Differentiated (5%)
    1. Lymphoma 3%
    2. Melanoma, Sarcoma, Other 2%
    3. Neuroendocrine tumors
  4. Squamous Carcinoma (5%)
    1. Specific Subgroup (4%)
    2. No specific subgroup (1%)
  5. Results based on
    1. Appearance under light microscope
    2. Special staining

C. Treatment of Special Subgroupsnavigator

  1. Women with Peritoneal Carcinomatosis
    1. Usually ovarian cancer
    2. Responds to platinum (and taxane) based therapies
    3. Maximal surgical cytoreduction prolongs survival
  2. Women with Axillary Node Metastases
    1. Breast cancer most common
    2. Modified radical mastectomy
    3. Chemotherapy
    4. Hormonal therapy
  3. Men with Elevated Serum PSA / Tumor staining for PSA
    1. Prostate CA most likely
    2. Hormonal therapy
  4. Squamous Carcinoma
    1. Most likely from head and neck
    2. Radiation therapy usually recommended
    3. Tumor above clavicle is a better prognostic sign
  5. Poorly differentiated neoplasms
    1. Outlook usually poor
    2. Empiric therapies have been tried
    3. Ifosfamide, carboplatin and etoposide based regimens are popular
    4. Increasing use of taxanes and gemcitabine as well

References navigator

  1. Hainsworth JD and Greco FA. 1993. NEJM. 329(4):257 abstract
  2. Yasuda S and Shohtsu A. 1997. Lancet. 350(9094):1819 abstract
  3. Burton EC, Troxclair DA, Newman WP III. 1998. JAMA. 280(14):1245 abstract