CUP Syndrome

Zaun, Gregor; Schüler, Martin; Herrmann, Ken; Tannapfel, Andrea

doi:10.3238/arztebl.2018.0157

Cited by 18 publications

(10 citation statements)

References 32 publications

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“…Carcinoma of unknown primary (CUP) is defined as a biopsy-proven metastasis from a malignant disease without a detectable primary site after complete clinical and radiological examinations [ 1 ]. The “CUP syndrome” occurs when metastatic cells have spread from the unknown primary site to multiple organs, with a 2-year survival rate of 20% [ 2 , 3 ]. This complex clinical entity accounts for approximately 2–4% of newly diagnosed cancers, commonly manifesting itself as metastases to the lymph nodes, followed by the liver, bone, and skin [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…The diagnostic and therapeutic algorithm for a CUP syndrome from OBC is based on its clinical presentation and on its histological and immunohistochemical analyses [ 6 , 7 ]. These patients should undergo basic breast diagnostics (i.e., bilateral mammography and breast ultrasound [US]), magnetic resonance imaging (MRI) of the breast [ 8 ], and positron emission tomography (PET)/computed tomography (CT) with 2-deoxy-2-[ 18 F]fluoro-D-glucose ( 18 F-FDG) [ 3 ]. In particular, MRI of the breast allows the diagnosis of an OBC in about 75% of women with CUP syndrome [ 9 ], and 18 F-FDG-PET/CT identifies the primary tumor in 25–40% of these cases [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Metastases from Occult Breast Cancer: A Case Report of Carcinoma of Unknown Primary Syndrome

et al. 2020

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Carcinoma of unknown primary (CUP) syndrome occurs when metastases from an unknown primary site spread to multiple organs. Occult breast cancer (OBC) is defined as a clinically recognizable metastatic carcinoma from an undetectable primary breast tumor. It accounts for 0.3–1% of all breast cancers, often presenting with lymph node, bone, and skin metastases. Clinical and radiological examinations represent the first steps in the diagnostic algorithm for CUP syndrome from OBC. However, histological and immunohistochemical analyses, multidisciplinary team evaluation, and a multidisciplinary therapy are essential in the diagnosis and treatment of CUP syndrome from OBC. We report the case of a 52-year-old woman who underwent the removal of a parietal skin lesion. The histological and immunohistochemical analyses suggested a breast cancer origin. Clinical assessment and laboratory and radiological examinations did not locate the primary tumor. Hormone therapy was offered to the patient; however, she refused it. After 28 months, the patient reported a right cervical lump, and a total-body positron emission tomography showed dissemination of the disease to the lymph nodes and bone. A CUP syndrome from OBC was diagnosed. A multimodality approach with radiotherapy and hormone and biological therapy was started. At present, 5 years from the first presentation, the patient is asymptomatic despite the disseminated disease.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Metastases from Occult Breast Cancer: A Case Report of Carcinoma of Unknown Primary Syndrome

et al. 2020

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“…In some guidelines, 18 F-FDG-PET/CT is used only as an additional supplement to routine tests. [11][12][13][14][15][16][17] (Lee2015) (Roh 2009)(Kwee2010) (Kwee2009)(Taylor2012)(Fizazi 2015)(Zaun2018)Yu et al in a large study involving 449 patients, found that PET/CT scans accurately detected the primary tumor in 115 patients, which inspired the use of PET/CT studies in patients at an early stage of diagnosis. (Yu 2016)However, it has also been argued that despite statistical evidence that PET/CT is a better tool for identifying the origin of cancer than MRI (22-44% vs. 20-27%).…”

Section: Introductionmentioning

confidence: 99%

Utility of 18F-FDG PET/CT in treatment strategies for patients with cancer of unknown primary

Huang

Zhang

2023

Preprint

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Objective To evaluate the role of 18F-FDG PET/CT imaging in primary tumor detection and treatment formulation in patients with cancer of unknown primary (CUP). Methods Sixty-two patients with CUP were selected from a database consisting of 18,802 cases in the Jiangsu Cancer Hospital PET/CT centre from 18 May 2016 to 18 November 2022. Clinical data and changes in treatment strategies before and after PET/CT were collected. Results A total of 42 primary tumors (42/62, 67.7%) were identified by PET/CT examination. The tumor staging of patients before conventional PET/CT imaging (such as CT/MRI/US) and after PET/CT did not change in 28 patients (28/62, 45.2%), whereas for 35 patients (34/62, 54.8%) tumor staging changed. Forty-five patients (45/62, 72.6%) had not developed treatment plans before PET/CT examination, but treatment plans were clarified after PET/CT examination. Thirteen patients (13/62, 21.0%) underwent changes in treatments before and after PET/CT examination. Among the 20 patients (20/62, 32.3%) whose primary tumors were not detected, 16 patients (16/20, 80.0%) had no treatment plans before PET/CT and the treatment plans were defined after PET/CT, three patients (3/20, 15.0%) changed the treatment plans before and after PET/CT, and one patient (1/20, 5.0%) did not change the treatment plan. Conclusion 18F-FDG PET/CT plays an important role in the detection and staging of primary tumors in patients with CUP. PET/CT findings can not only help clinicians develop appropriate treatment plans for patients with CUP, but also serve as an effective approach to improve real-life treatment strategies for these patients.

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“…A diagnosis of CUP is evocated when the clinical picture of metastatic disease is associated with one or more tissue biopsy results that are inconsistent with a determined primary tumor. Two to four percent of newly diagnosed cases of carcinoma are CUP 3 ; histological subtypes of these CUP are adenocarcinomas (40–60%), undifferentiated carcinomas (15–30%), and SCCs (15–20%) 4 . Patients with CUP syndrome have a median survival of 8–11 months and only 25% survive at 1 year 5 .…”

Section: Introductionmentioning

confidence: 99%

Somatic substitution signature as an innovative tool in lung cancer diagnosis

Busca¹,

Salleron²,

Boidot³

et al. 2019

Sci Rep

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Diagnosis of lung cancer can sometimes be challenging and is of major interest since effective molecular-guided therapies are available. Compounds of tobacco smoke may generate a specific substitutional signature in lung, which is the most exposed organ. To predict whether a tumor is of lung origin or not, we developed and validated the EASILUNG (Exome And SIgnature LUNG) test based on the relative frequencies of somatic substitutions on coding non-transcribed DNA strands from whole-exome sequenced tumors. Data from 7,796 frozen tumor samples (prior to any treatment) from 32 TCGA solid cancer groups were used for its development. External validation was carried out on a local dataset of 196 consecutive routine exome results. Eight out of the 12 classes of substitutions were required to compute the EASILUNG signature that demonstrated good calibration and good discriminative power with a sensitivity of 83% and a specificity of 72% after recalibration on the external validation dataset. This innovative test may be helpful in medical decision-making in patients with unknown primary tumors potentially of lung origin and in the diagnosis of lung cancer in smokers.

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CUP Syndrome

Abstract: SummaryBackground: 2-4% of newly diagnosed cases of malignant disease involve cancer of unknown primary (CUP). This mixed entity is one of the 6 most common types of malignant disease in Germany. Highly refined treatment strategies can now be offered to patients with CUP.

Cited by 18 publications

References 32 publications

Metastases from Occult Breast Cancer: A Case Report of Carcinoma of Unknown Primary Syndrome

Metastases from Occult Breast Cancer: A Case Report of Carcinoma of Unknown Primary Syndrome

Utility of 18F-FDG PET/CT in treatment strategies for patients with cancer of unknown primary

Somatic substitution signature as an innovative tool in lung cancer diagnosis

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