Because 1 percent and 9 percent of cancer patients present with metastatic cancer from unknown primary site, it is uncertain why some cases metastasis may develop and become more prominent than the primary site. Work-up includes a detailed history and complete physical examination (including, pelvic and rectal income)

Epidemiologic risk factors, exposures and family history are important. Be like Sherlock Holmes and do not dismiss any clue. A key step is to discuss (beforehand if possible) with the pathologist what studies are most likely to be helpful. Above the diaphragm, it is the pancreas. In a woman, always consider breast cancer.

Also, melanoma, kidney cancer and nasopharyngeal cancer are very sneaky in both sexes. Axillary carcinoma in a woman will usually be of breast origin. A squamous cell cancer arising in a neck node will usually be from the head neck area. A triple endoscopy should be done. Umbilical adenocarcinomas will most likely be a stomach primate.

In a young man with mediastinal mass, consider extregeonadal germ cell tumors which are highly responsive to chemotherapy. Even a post-mortem exams, the primary site is not identified in 15 percent.

If you can establish a diagnosis, do so and treat as you would that primary. Manage symptomatic local sites with radiation therapy or surgical excision. If surgisquamous cell carcinoma is in the neck, treat as if the head and neck metastasis with multidisciplinary approach if male, consider using a platinum based regimen in the event it may be of germ cell origin. If female, consider breast cancer as a potential culprit, and a doxorubin based program for an emeric trial.

source: Philippine Star
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