Cancers of unknown primary origin: current perspectives and future therapeutic strategies

Abstract

It is widely accepted that systemic neoplastic spread is a late event in tumour progression. However, sometimes, rapidly invasive cancers are diagnosed because of appearance of metastatic lesions in absence of a clearly detectable primary mass. This kind of disease is referred to as cancer of unknown primary (CUP) origin and accounts for 3-5% of all cancer diagnosis. There is poor consensus on the extent of diagnostic and pathologic evaluations required for these enigmatic cases which still lack effective treatment. Although technology to predict the primary tumour site of origin is improving rapidly, the key issue is concerning the biology which drives early occult metastatic spreading. This review provides the state of the art about clinical and therapeutic management of this malignant syndrome; main interest is addressed to the most recent improvements in CUP molecular biology and pathology, which will lead to successful tailored therapeutic options.

Figure 1

Tacking the primary: from multiple malignant nodules to CUPs.

Figure 2

Diagnostic algorithm to characterize metastatic adenocarcinoma from unknown primary. (CK: cytokeratin; TTF1: thyroid transcription factor 1; ER: estrogen receptor; CA125: cancer antigen 125; tireo: tireoglobulin; VIM: vimentin; PSA: prostate specific antigen)