不明原發(fā)灶腫瘤的診斷詳解演示文稿

不明原發(fā)灶腫瘤的診斷詳解演示文稿目前一頁\總數(shù)一百二十八頁\編于點（優(yōu)選）不明原發(fā)灶腫瘤的診斷目前二頁\總數(shù)一百二十八頁\編于點目前三頁\總數(shù)一百二十八頁\編于點目前四頁\總數(shù)一百二十八頁\編于點目前五頁\總數(shù)一百二十八頁\編于點目前六頁\總數(shù)一百二十八頁\編于點目前七頁\總數(shù)一百二十八頁\編于點目前八頁\總數(shù)一百二十八頁\編于點目前九頁\總數(shù)一百二十八頁\編于點CUP

Pathophysiology

◆Cancersarethoughttoarisefromasinglecellthatescapesthecontrolsofnormalcellreplication◆Formsatumoratthesiteoforigin◆Ultimatelymetastasizestootherorgans目前十頁\總數(shù)一百二十八頁\編于點CUP

Pathophysiology◆Insomecasestheoriginaltumormayremainsmallorundetectableatthetimeofmetastasis◆LeadingtotheclinicalpresentationofCUP目前十一頁\總數(shù)一百二十八頁\編于點CUPFrequency◆UnitedStates:2-6%

◆International:2-9%目前十二頁\總數(shù)一百二十八頁\編于點CUPMortality/Morbidity◆Mediansurvival

rangesfrom11weeksto11months◆The5-yearoverallsurvivalrateisabout11%目前十三頁\總數(shù)一百二十八頁\編于點CUPSex◆Anapproximateequalincidenceformenandwomen目前十四頁\總數(shù)一百二十八頁\編于點CUP

Age◆Themedianageonpresentationforbothmenandwomenrangesfrom59-66years目前十五頁\總數(shù)一百二十八頁\編于點CUP

CLINICAL(History)◆Becausemostpatientswithcuphavefairlyadvanced-stagedcancers◆Theconstitutionalsymptomsofmalaise,weakness,fatigue,andweightlossarepresentinnearlyallpatients

目前十六頁\總數(shù)一百二十八頁\編于點

CUPCLINICAL(Physical)◆Theclinicalpresentationofcupisextremelyvariable◆Dependsontheextentandtypeoforganinvolvement目前十七頁\總數(shù)一百二十八頁\編于點CUP

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一群異源發(fā)生的腫瘤◆除外淋巴瘤、轉(zhuǎn)移性黑色素瘤和轉(zhuǎn)移性肉瘤◆集中于上皮細胞組織，包括腺癌、鱗狀上皮細胞癌、分化不良上皮癌和神經(jīng)內(nèi)分泌癌目前十八頁\總數(shù)一百二十八頁\編于點CUP

CUP的診斷標(biāo)準(zhǔn)◆組織活檢證實為惡性腫瘤(活檢部位不能檢出原發(fā)灶)◆經(jīng)過徹底地收集病史或物理檢查(包括女性盆腔檢查和男性睪丸及前列腺觸診)未發(fā)現(xiàn)原發(fā)性腫瘤目前十九頁\總數(shù)一百二十八頁\編于點CUP

◆

CUP實驗室檢查結(jié)果正常，包括完整的血細胞計數(shù)、血液生化、胸部X線、腹部和盆腔CT、乳房影像學(xué)檢查或前列腺特異性抗原(PSA)檢查等等目前二十頁\總數(shù)一百二十八頁\編于點CUPCLINICAL◆完整的病史和徹底的體格檢查是診斷CUP的基本前提，尤其是既往組織活檢結(jié)果◆家族史很可能提示遺傳性非息肉病性結(jié)腸癌或乳腺癌易感性目前二十一頁\總數(shù)一百二十八頁\編于點CUP◆徹底的體檢可能會發(fā)現(xiàn)特異性原發(fā)腫瘤◆左側(cè)鎖骨上淋巴結(jié)腫大(Virehow’S結(jié)節(jié))(胃Ca?)◆臍周淋巴結(jié)腫大或包塊(SisterMaryJosph’S結(jié)節(jié)-由惡性腹水造成的腹脹以及臍周腫塊{臍孔腫大變硬,產(chǎn)生冰山樣臍部腫塊})(低分化癌-胃腸道)◆腹股溝淋巴結(jié)腫大、肛周包塊(肛門腫瘤)目前二十二頁\總數(shù)一百二十八頁\編于點

CUPCLINICAL(Physical)◆Themostcommonsitesofinvolvementbeinglung,bone,lymphnodes,andliver目前二十三頁\總數(shù)一百二十八頁\編于點CUPCLINICAL(Physical)◆Includingheadandneck,rectal,testicular,pelvic,andbreastexaminations目前二十四頁\總數(shù)一百二十八頁\編于點CUPCLINICAL(Physical,Labandradiologicalstudies

)◆

Acompletebloodcellcount(irondeficiencymaypointtowardanoccultgastrointestinalmalignancyleadingtochronicbloodloss)目前二十五頁\總數(shù)一百二十八頁\編于點CUPCLINICAL(Physical,Labandradiologicalstudies

)◆urinalysis(microscopichematuriamaybeasignofoccultgenitourinarymalignancy)目前二十六頁\總數(shù)一百二十八頁\編于點CUPCLINICAL(Physical,Labandradiologicalstudies

)◆

liverandrenalfunctiontests◆stoolforoccultblood◆chestradiograph目前二十七頁\總數(shù)一百二十八頁\編于點CUPCLINICAL(Physical,Labandradiologicalstudies

)◆

abdomenandpelvisCT◆mammographyinwomen◆measurementofPSAinmen目前二十八頁\總數(shù)一百二十八頁\編于點CUPPhysicalAscitesshouldleadonetoevaluateforaGIoranovarianprimaryAnaxillarymassinafemaleshouldmakethecliniciancheckforbreastcancerAcervicalnodeshouldleadtoathoroughENTexamination目前二十九頁\總數(shù)一百二十八頁\編于點CUPPhysicalAbrainmetastasisshouldleadtoasearchforalung,breast,orkidneyprimaryBonemetastasisshouldleadtoevaluationforprostate,breast,lung,renal,orthyroidprimary目前三十頁\總數(shù)一百二十八頁\編于點CUPPhysicalAtesticularmassshouldleadtomeasurementoftumormarkerssuchasbeta-HCGandAFP目前三十一頁\總數(shù)一百二十八頁\編于點CUPPhysicalDependingontheclinicalsituation,thesemayincludechestCT,breastMRI,upperorlowerendoscopy目前三十二頁\總數(shù)一百二十八頁\編于點CUPCLINICAL(Physical)◆Insuspectedheadandneckmalignancies,panendoscopyoftheupperaerodigestivepathwaysshouldbeperformedwithevenasindicatedblindbiopsiesofthelymphoidtissueintheseareas目前三十三頁\總數(shù)一百二十八頁\編于點CUPCLINICAL(Physical)◆

Diagnostictonsillectomymaybewarranted目前三十四頁\總數(shù)一百二十八頁\編于點CUPCLINICAL(Physical)◆Intensivetestingalsoaddstothemorbidityfortheweakandfrailpatient目前三十五頁\總數(shù)一百二十八頁\編于點CUPCLINICAL(Physical)◆

Alargenegativecost-to-benefitratioexistsforanextensiveunguidedclinicalevaluation目前三十六頁\總數(shù)一百二十八頁\編于點CUPCLINICAL(Physical)◆

Onestudyquotinga9.5%increasein1-yearsurvivalatacostof2-8milliondollars目前三十七頁\總數(shù)一百二十八頁\編于點CUPCLINICAL(Physical)◆Whentheseinvestigationsfailtorevealapotentialprimarylesion,acancerofunknownprimaryoriginisassumed目前三十八頁\總數(shù)一百二十八頁\編于點CUPWORKUP(ImagingStudies)◆18F-FDG-PETisincreasinglybeingusedintheevaluationofmetastaticmalignancies目前三十九頁\總數(shù)一百二十八頁\編于點CUPWORKUP(ImagingStudies)◆Thismaybeespecially

thecaseinsuspectedheadandneckmalignancies目前四十頁\總數(shù)一百二十八頁\編于點CUPWORKUP(ImagingStudies)◆Thistestinglacksspecificityandmayonlybeusefultoidentifypromisingsitesforbiopsy目前四十一頁\總數(shù)一百二十八頁\編于點CUPWORKUP(ImagingStudies)◆18氟-脫氧葡萄糖(18F-FDG)-PET可輔助指導(dǎo)活組織檢查，確定疾病程度和輔助選擇恰當(dāng)?shù)闹委熌壳八氖揬總數(shù)一百二十八頁\編于點CUPWORKUP(ImagingStudies)◆Althoughpromising,highcostandfalsepositiveratesof20%limititsutilityincasesofCUP◆ThecombinationofPET/CTmayreducethefalse-positiverate目前四十三頁\總數(shù)一百二十八頁\編于點CUPOtherTests◆TheroleoftumormarkerslikeAFP,beta-HCG,CA125,CA27.29,CA19.9,andCEAtoestablishaspecificprimarysite目前四十四頁\總數(shù)一百二十八頁\編于點CUPOtherTests◆Mosttumormarkersarenonspecific◆Itmaynotbeusedtoestablishdefinitivediagnoses目前四十五頁\總數(shù)一百二十八頁\編于點CUPOtherTests◆男性腺癌和骨轉(zhuǎn)移，常規(guī)檢查血清PSA◆男性未分化癌和低分化癌，檢測B-HCG和AFP,AFP也用于診斷HCC◆B-HCG和AFP水平并不能預(yù)測化療效果或生存期目前四十六頁\總數(shù)一百二十八頁\編于點CUPOtherTests◆CEA、CA125、CA19-9和CA15-3對于確定原發(fā)灶沒有幫助◆大多數(shù)血清腫瘤標(biāo)記物是非特異性的，可判斷預(yù)后目前四十七頁\總數(shù)一百二十八頁\編于點CUPProcedures◆Abiopsyofthemetastaticsite◆Acarefulevaluationofthepathology目前四十八頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings◆ThepathologisthasanindispensableroleintheevaluationofCUP目前四十九頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings◆Needlebiopsyspecimensmayprovideinsufficienttissuefordiagnosisorprovidetissuethathasbeentoo

damaged

ordistortedbythebiopsyprocedureforaccuratediagnosis

目前五十頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings◆Variousimmunoperoxidase(免疫過氧化物酶)stainsareavailableforprovidingadifferentialdiagnosis

forCUP目前五十一頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings◆

AppropriateDNAmicroarray(微陣列)techniquesandproteonomic(蛋白質(zhì)組學(xué))studiestoestablishadefinitivediagnosis目前五十二頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings◆

如果查不到原發(fā)腫瘤，要想確定各種CUP患者的治療策略和判斷預(yù)后是非常困難的目前五十三頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings◆免疫組化和影像學(xué)聯(lián)合檢查的診斷率約為20％-30％◆目前認為,最有前途的可提高診斷率的方法是腫瘤的分子診斷?，F(xiàn)有的基因表達數(shù)據(jù)庫對于CUP的診斷極有幫助目前五十四頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings◆預(yù)警基因分為兩類，一類是在某些起源組織中特異性表達的基因，另一類是在各種腫瘤中均有異常表達的基因目前五十五頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings◆

一批源于l0種普通腫瘤的100個原發(fā)癌樣品，用110個在這些腫瘤中表達最低的基因開發(fā)了一個預(yù)警芯片。對另外75個盲樣(包括l2個轉(zhuǎn)移癌樣品)進行檢驗，預(yù)測腫瘤原發(fā)灶的正確率大于90％，12個轉(zhuǎn)移癌中有l(wèi)1個被正確分類目前五十六頁\總數(shù)一百二十八頁\編于點CUPHistologicFindin◆對218個腫瘤(14個普通類型)組織和90個正常組織樣品的寡核苷酸微陣列基因表達進行分析，用16063個基因表達的相對水平和表達基因的序列標(biāo)簽開發(fā)了一個基因預(yù)警芯片目前五十七頁\總數(shù)一百二十八頁\編于點CUPHistologicFindin◆

對54個腫瘤樣品(其中8例轉(zhuǎn)移性腫瘤)檢測，總的預(yù)測正確率是78％，轉(zhuǎn)移性腫瘤中有6例被正確識別出原發(fā)部位◆提示腫瘤保留其組織起源標(biāo)記物是貫穿于轉(zhuǎn)移過程的始終目前五十八頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings◆引用一系列基因表達庫的分析數(shù)據(jù)和相關(guān)腫瘤標(biāo)記物的文獻資料確定了61個基因為候選腫瘤基因，以其表達模式預(yù)測起源位置。用反轉(zhuǎn)錄PCR對原發(fā)性腺癌樣品(包括乳腺、卵巢、胃、胰腺和肺)檢測了其中11個基因，7個(64％)基因存在組織特異性◆這些組織限制性腫瘤標(biāo)志物能夠用于CUP原發(fā)性腫瘤可能位點的預(yù)測目前五十九頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings◆Putsthetissuespecimenthrough1-4steps,dependingontheneed目前六十頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings◆lightmicroscopy◆Immunohistochemicalstains◆Electronmicroscopy◆Chromosomalanalysisincludingcytogenetics目前六十一頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings

◆Lightmicroscopy:epithelialcancers,lymphomas,sarcomas,melanomas,orgermcelltumors目前六十二頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings◆Whencytologicdistinguishingfeaturesarelimited,thetumormaybeclassifiedasundifferentiatedorpoorlydifferentiatedcarcinoma目前六十三頁\總數(shù)一百二十八頁\編于點

CUPHistologicFindings

◆Immunohistochemistry:Thesetestshelpdefinetumorlineagebyusingperoxidase-labeledantibodyagainstspecifictumorantigens目前六十四頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings

◆

Theseincludestainsforkeratin,LCAandS-100(expressedinmelanomas),TTF-1(forlungandthyroidcancer),PSA,HCG(forgermcelltumors),AFP(forgerm-celltumorsandhepatomas),ER,PR,andHer-2(forbreastcancer)目前六十五頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings

◆CK20在胃腸道上皮、泌尿道上皮和Merkel細胞中表達◆CK7在肺癌、卵巢癌、子宮內(nèi)膜癌和乳腺癌中有表達；而在低位胃腸道腫瘤未發(fā)現(xiàn)表達◆CK20陽性和CK7陰性強烈支持結(jié)腸原發(fā)腫瘤。75％～95％的結(jié)腸腫瘤呈現(xiàn)此染色模式◆肺癌僅有9％～15％CK20呈陽性，這有助于肺內(nèi)轉(zhuǎn)移性腺癌原發(fā)灶的鑒別目前六十六頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings

◆CK20陰性和CK7陽性將鑒別診斷縮小至肺癌、乳腺癌、膽管癌、胰腺癌、卵巢癌和子宮內(nèi)膜癌◆應(yīng)用TTF-1和表面活性物質(zhì)脫輔基蛋白(surfactantapoprotein)可將原發(fā)性肺癌從其他CK7陽性腫瘤中區(qū)分出來目前六十七頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings◆

TTF-1是一種38kD的含有同源結(jié)構(gòu)域的核蛋白，在甲狀腺、中腦和呼吸道上皮胚胎發(fā)生過程的轉(zhuǎn)錄活化中起作用◆TTF-1在肺癌和甲狀腺癌呈典型陽性染色◆有利于對轉(zhuǎn)移性頸部淋巴結(jié)腫大和轉(zhuǎn)移性胸腔積液的原發(fā)腫瘤的診斷目前六十八頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings

◆Electronmicroscopy:Thisstudyhaslimitedutilityinidentificationoftheprimarysiteofcancerofunknownprimaryoriginbutmayrarelybeusedinpoorlydifferentiatedtumors目前六十九頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings◆Chromosomalstudies:IncasesofCUPwithsuspectedoccultNPC,DNAamplificationofEpsteinBarrvirus(EBV)intissuemayclinchthediagnosis目前七十頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings◆Thepresenceofiso-chromosome12p,i(12p),aspecificchromosomalmarkercharacteristicofgermcelltumorscanhelpdiagnoseextragonadalgermcelltumorsinpatientswithCUP目前七十一頁\總數(shù)一百二十八頁\編于點CUPHistologicFindings◆生殖細胞腫瘤有特征性的細胞遺傳學(xué)改變(等臂染色體12p-i[12p]◆拷貝數(shù)增加或12號染色體長臂缺如◆與無染色體異常的患者相比，生殖細胞腫瘤有染色體異常的患者對順鉑為主的化療有更好的反應(yīng)目前七十二頁\總數(shù)一百二十八頁\編于點CUP◆

ThemajorityofCUPareadenocarcinomasorundifferentiatedtumors(upto58%insomestudies)目前七十三頁\總數(shù)一百二十八頁\編于點CUP◆Lesscommonly,squamouscellcarcinoma,melanoma,sarcoma,andneuroendocrinetumorscanalsopresentasmetastasiswithanunknownprimarysiteoforigin目前七十四頁\總數(shù)一百二十八頁\編于點CUP◆Moststudiesexcludesarcomasandmelanomasfromtheiranalysis

目前七十五頁\總數(shù)一百二十八頁\編于點CUP◆Intheapproximately30%ofCUP,themostcommonepithelialmalignanciesarelung(15%),pancreas(13%),colon/rectum(6%),kidney(5%),andbreast(4%)目前七十六頁\總數(shù)一百二十八頁\編于點CUP◆Sarcomas,melanomas,andlymphomaseachcontribute6-8%目前七十七頁\總數(shù)一百二十八頁\編于點CUP◆Theremainingprimarytumorsarethoseofstomach(4%),ovary(3%),liver(3%),esophagus(3%),prostate(2%),andavarietyofothermalignancies(22%)目前七十八頁\總數(shù)一百二十八頁\編于點CUP◆StagingPatientswithcancerofunknownprimaryoriginarepresumedtoallhavestageIVdiseaseatthetimeofinitialpresentation目前七十九頁\總數(shù)一百二十八頁\編于點CUP◆CUP表現(xiàn)為轉(zhuǎn)移性疾病但未找到原發(fā)灶目前八十頁\總數(shù)一百二十八頁\編于點CUP◆原發(fā)灶隱匿的原因可能與以下因素有關(guān)機體的免疫機制控制了原發(fā)灶，于轉(zhuǎn)移后消失原發(fā)灶太小，不能被目前的檢查方法所發(fā)現(xiàn)目前八十一頁\總數(shù)一百二十八頁\編于點CUPNaresh[19]假設(shè)認為◆原發(fā)灶血供改變使其生長受抑◆在內(nèi)臟，轉(zhuǎn)移灶可能處于靜止期，直到有生成血管表型的亞克隆出現(xiàn)，才導(dǎo)致轉(zhuǎn)移性腫瘤迅速生長◆在腫瘤發(fā)生過程中，轉(zhuǎn)移灶發(fā)生于晚期的傳統(tǒng)理論正受到質(zhì)疑◆新的數(shù)據(jù)提示，腫瘤發(fā)生早期即有轉(zhuǎn)移傾向目前八十二頁\總數(shù)一百二十八頁\編于點CUP◆CUP的原發(fā)性腫瘤極有可能從一開始就有“預(yù)后不良”的特征◆分子靶點和DNA微陣列在CUP診斷中的應(yīng)用正在開展◆揭示轉(zhuǎn)移癌的發(fā)病機制◆促進新的治療藥物的開發(fā)目前八十三頁\總數(shù)一百二十八頁\編于點CUP◆代表腫瘤類型的、已知的原發(fā)性腫瘤基因引入診斷CUP◆無足夠的源于原發(fā)性腫瘤轉(zhuǎn)移灶樣品的基因表達數(shù)據(jù)，尤其是低分化腫瘤目前八十四頁\總數(shù)一百二十八頁\編于點CUP◆DNA微陣列與更大規(guī)模的免疫組化標(biāo)記物和轉(zhuǎn)移模式相結(jié)合◆提高預(yù)測CUP起源位置的正確率◆原發(fā)灶與其轉(zhuǎn)移灶的基因轉(zhuǎn)錄譜的對比性研究

目前八十五頁\總數(shù)一百二十八頁\編于點Thanksforyourattention!目前八十六頁\總數(shù)一百二十八頁\編于點CUPTREATMENT(MedicalCare)

◆Multipleorganinvolvementandpoorperformancestatus

isgrave

目前八十七頁\總數(shù)一百二十八頁\編于點CUPTREATMENT(MedicalCare)◆Themediansurvivalisonly3-4months◆The1-yearsurvivalrateislessthan

15%◆The5-yearsurvivalof

5-10%目前八十八頁\總數(shù)一百二十八頁\編于點CUPPoorprognosticmarkers

◆malesex◆multiplebrainmetastases◆pleural/lunginvolvement◆liverinvolvement◆adrenalinvolvement◆adenocarcinomahistology目前八十九頁\總數(shù)一百二十八頁\編于點CUPFavorableprognosticmarkers

◆lymphnodeinvolvement

◆neuroendocrinehistology

目前九十頁\總數(shù)一百二十八頁\編于點CUPTREATMENT(cervicallymphnodes)

◆

Upperaerodigestivetract,includingdirectvisualizationofthehypopharynx,nasopharynx,larynx,andupperesophagus目前九十一頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆

Squamous◆Adenocarcinoma◆Melanoma◆Anaplastictumors(間變性腫瘤)目前九十二頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆Squamousorundifferentiatedcarcinoma,tonsillectomiesshouldbeconsidered目前九十三頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆Cervicaladenopathycanbetheprimarydiseasemanifestationin2-5%ofpatientswithprimarysquamouscellcarcinomaoftheheadandneckregion目前九十四頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆Intheabsenceoflocalizationofaprimarysite,aggressivelocaltherapyisindicated.Thismayinvolveanyofthefollowing:

目前九十五頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆Radicalradiationtherapywithcurativeintenttotheneckandpossiblesiteoforigin

目前九十六頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆Preoperativeradiationtherapyfollowedbyradicalneckdissection◆Radicalneckdissection◆Radicalneckdissectionfollowedbyradiationtopossiblesitesoforigin目前九十七頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆

Five-yearsurvivalratesashighas30-50%havebeenachievedwiththisapproach目前九十八頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆

Roleofchemotherapyisdebated目前九十九頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆Onerandomizedstudyshowedimprovedresponserateandmediansurvivalwithcisplatinand5-fluorouracil—basedchemotherapywhencomparedtoradiationalone目前一百頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆

Asingleadenocarcinoma-involved

lymphnodeineitherthecervicaloringuinalareaswithnoevidenceofdiseaseelsewheremaybemanagedwithsurgicalexcisionaloneandwatchful

expectation目前一百零一頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆

Radiationtherapytotheinvolvedandlocalfieldsmaybeprovidedaswell目前一百零二頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆

Combinationtherapymaybesuperiortomonotherapywith5-yearsurvivalratesof35%reported目前一百零三頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆

Metastaticadenocarcinomapresentingasisolatedaxillarylymphadenopathyinwomenisusuallyamanifestationofanoccultbreastprimarycancer目前一百零四頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆

Mastectomyspecimensinthissubsetofpatientshaveshownapreviouslyundiagnosedbreastprimarytumorin40-70%cases

目前一百零五頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆

ImmunohistochemicalstainswithERandPRshouldbeperformedinthissetting,astheymayaidindiagnosis

目前一百零六頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆

Modifiedradicalmastectomywithaxillarynodedissectionhasbeenadvocated目前一百零七頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆

Astudywith42patients,however,showedimprovedsurvivalwithsystemicchemotherapyandimprovedlocalcontrolwithbreastandaxillaryradiation目前一百零八頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆

Localexcision◆Ashavingprimarybreastcancer◆50%ofpatientsachieve2-10yearsurvival◆Currently,managementisbasedontheguidelinesforstageIIbreastcancer

目前一百零九頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆

Womenwithperitonealcarcinomatosiswithadenocarcinoma

havesimilaritieswithpatientswithovariancancer

目前一百一十頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆

Papillaryhistology◆ElevationofCA125◆Agoodresponsetoplatinum-basedchemotherapy◆Butaprimarytumorisnotrevealedonexploratorylaparotomy

目前一百一十一頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆Metastaticmelanomatoasinglenodalsite◆5%ofpatientswithmalignantmelanomamaypresentwithnodalmetastasisintheabsenceofadocumentedprimarysite目前一百一十二頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆

Theyshouldbetreatedwithradicallymphnodedissection◆Survival,surprisingly,isslightlybetterthanthatforstageIImelanomainpatientswithaknownprimarysite目前一百一十三頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆Poorlydifferentiatedandundifferentiatedcarcinoma◆1/3CUP◆Canbepotentiallycurable◆Includeslymphomas,germcelltumors,orneuroendocrinetumors目前一百一十四頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆Thefeaturesthatpointtowardatreatment-responsivetumorincludethefollowing:◆Patientyoungerthan50years

◆Midlinedistribution,withelevatedlevelsofbeta-HCGorAFP目前一百一十五頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆Beta-HCG/AFPpositiveonimmunohistochemistry◆Neuroendocrinegranules◆Rapidtumorgrowth◆Iso-chromosome12pinmidlinetumors目前一百一十六頁\總數(shù)一百二十八頁\編于點CUPTREATMENT◆Platinum-basedcombinationCTregimensspecificfor