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Review
. 2018 Nov;20(11):1361-1372.
doi: 10.1007/s12094-018-1899-z. Epub 2018 May 28.

2018 consensus statement by the Spanish Society of Pathology and the Spanish Society of Medical Oncology on the diagnosis and treatment of cancer of unknown primary

F Losa  1 , L Iglesias  2 , M Pané  3 , J Sanz  4 , B Nieto  5 , V Fusté  6 , L de la Cruz-Merino  7 , Á Concha  8 , C Balañá  9 , X Matías-Guiu  10
Affiliations
Review

2018 consensus statement by the Spanish Society of Pathology and the Spanish Society of Medical Oncology on the diagnosis and treatment of cancer of unknown primary

F Losa et al. Clin Transl Oncol. 2018 Nov.

Abstract

Cancer of unknown primary (CUP) is defined as a heterogeneous group of tumours that present with metastasis, and in which attempts to identify the original site have failed. They differ from other primary tumours in their biological features and how they spread, which means that they can be considered a separate entity. There are several hypotheses regarding their origin, but the most plausible explanation for their aggressiveness and chemoresistance seems to involve chromosomal instability. Depending on the type of study done, CUP can account for 2-9% of all cancer patients, mostly 60-75 years old. This article reviews the main clinical, pathological, and molecular studies conducted to analyse and determine the origin of CUP. The main strategies for patient management and treatment, by both clinicians and pathologists, are also addressed.

Keywords: Biopsy; Cancer of unknown primary; Chemotherapy; Diagnosis; Histopathology; Immunohistochemistry; Molecular pathology; Prognosis.

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Conflict of interest statement

Conflict of interest

The authors declare that, when writing and revising the text, they did not know the names of the pharmaceutical companies that provided financial support for this project, so this support has not influenced the content of this article.

Ethical approval

The study has been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments. This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Figures

Fig. 1
Fig. 1
Advisable minimum IHC panel. IHC immunohistochemistry
Fig. 2
Fig. 2
Summary of proposed management of cancer of unknown primary
Fig. 3
Fig. 3
SEAP diagnostic algorithm. Sample material should be obtained by imaging or surgical techniques, preferably in the form of a core-needle, incisional or excisional biopsy. In the pathology department, optimal use of the material should be ensured. This may mean separating fragments into different paraffin blocks to save material for future use, if necessary. Tests should then be done using a basic immunohistochemical panel, according to morphology, and an advanced immunohistochemical panel, based on information obtained from the basic panel, clinical features, and microscopy findings. The recommended number of stains is approximately 7. The aim is to preserve material for possible use of a molecular platform
See this image and copyright information in PMC

References

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    1. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Occult Primary (Cancer of Unknown Primary [CUP]) Version 1.2018–November 9, 2017. https://www.nccn.org/professionals/physician_gls/pdf/occult.pdf. Accessed 2 Jan 2018.
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