Risk factors for cancers of unknown primary site: Results from the prospective EPIC cohort

Kaaks, Rudolf; Sookthai, Disorn; Hemminki, Kari; Krämer, Alwin; Boeing, Heiner; Wirfält, Elisabet; Weiderpass, Elisabete; Overvad, Kim; Tjønneland, Anne; Olsen, Anja; Peeters, Petra H.M.; Bueno‐de‐Mesquita, H. Bas; Panico, Salvatore; Pala, Valeria; Víneis, Paolo; Quiŕos, J. Ramón; Ardanáz, Eva; Sánchez, María José; Chirlaque, María Dolores; Larrañaga, Nerea; Brennan, Paul; Trichopoulos, Dimitrios; Trichopoulou, Antonia; Λάγιου, Παγώνα; Hallmans, Göran; Khaw, Kay Tee; Key, Timothy J.; Riboli, Elio; Canzian, Federico

doi:10.1002/ijc.28874

Cited by 45 publications

(77 citation statements)

References 15 publications

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“…A recent European study published in this Journal showed that heavy smoking causes a risk of 3.66 for CUP patients of diverse and unspecified histologies; alcohol drinking and wide waist circumference were borderline risk factors. 2 The pathophysiology of CUP has remained an enigma, exemplified by the question presented in a review on CUP: "unknown primary or unknown biology?" 3 The inability to find a primary tumor may not merely depend on its small size but may involve newly described cell biological processes related to stem cell characteristics, microenvironment, immunoediting and senescence-apoptosis which may halt tumor growth and induce phenotypic changes.…”

Section: Dear Sirmentioning

confidence: 99%

Smoking and body mass index as risk factors for subtypes of cancer of unknown primary

et al. 2014

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Cancer of unknown primary site (CUP) accounts for 3-5% of all cancer but because it is a fatal disease it ranks high among causes of cancer deaths. It has been called "an orphan disease" because it is diagnosed through metastatic tissue and the primary tumor often remains undetected. Based on autopsy data, the most common primaries were lung (27%), pancreas (24%), liver/bile (8%) and kidney/adrenals (8%). 1 CUP can be called "orphan disease" also because, as a metastatic disease, it is disregarded as a cancer entity when only primary cancers are considered. Thus, hardly anything is known about the underlying causes or risk factors. A recent European study published in this Journal showed that heavy smoking causes a risk of 3.66 for CUP patients of diverse and unspecified histologies; alcohol drinking and wide waist circumference were borderline risk factors. 2 The pathophysiology of CUP has remained an enigma, exemplified by the question presented in a review on CUP: "unknown primary or unknown biology?" 3 The inability to find a primary tumor may not merely depend on its small size but may involve newly described cell biological processes related to stem cell characteristics, microenvironment, immunoediting and senescence-apoptosis which may halt tumor growth and induce phenotypic changes. [3][4][5] In essence, an increased understanding of the interplay of host and tumor during the protracted process of carcinogenesis has made CUP less of a conundrum and more as a learning opportunity, in a 21st century parallel to the cancer biology gains provided by unravelling of several hereditary cancer syndromes in the previous century. Our recent studies support these data and suggest that the lung is a more common primary tissue than what the earlier data show. [6][7][8] In the present letter, we extend the study of Kaaks et al. addressing the question of tobacco smoking and body mass index (BMI) as risk factors of site-specific CUP, that is, by location of the diagnosed metastasis. 2 We hypothesize that smoking would have an effect on sites where smoking risks are highest among primary cancers, that is, lung. Patients and cancer-free controls were recruited from three Swedish prospective biobanks, the Umea Medical Biobank with 203 CUP patients and 1015 controls and the Malmo Diet and Cancer Study and the Prevention Study, jointly with 272 CUP patients and 1360 controls; 9 the controls were frequency matched on sex and age at interview. In Umea, the mean age at sampling was 57 years and at diagnosis it was 66 years; in Malm€ o, the respective ages were 51 and 71 years. Cancers were identified up to year 2012 through the regional Oncology Centers. Diagnoses were based on International Classification of Diseases (ICD) codes 7, 9 and 10, the latter two were particularly useful because they included the anatomic site where metastases were found. These included "unspecified CUP" (ICD-9 code 1990-1991, CUP often spread to multiple organs), "liver CUP" with liver metastasis, "lung CUP" with lung involvement (including thorax ...

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Section: Dear Sirmentioning

confidence: 99%

Smoking and body mass index as risk factors for subtypes of cancer of unknown primary

et al. 2014

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“…However, the period from the first visit to local physicians to being informed of diagnosis (Phase 2 to Phase 3) was longer in our patients with CUP. Especially, in our CUP cases, anxiety persisted with loneliness even after diagnosis, which was thought to derive from 'uncertainty' and 'orphan disease' characterizing CUP (24,25).…”

Section: Experience Of Patients With Cup Until Initial Treatmentmentioning

confidence: 99%

“…Therefore, the patients with CUP sometimes felt tensions for the relationship (data not shown). Supportive and nursing care needs to be provided beyond the otherwise disadvantageous situation of patients with CUP from outpatient visit period to in-hospital period in order to reduce psychological burden from loneliness by 'orphan' state (24).…”

Section: Experience Of Patients With Cup Until Initial Treatmentmentioning

confidence: 99%

Psychological burden on patients with cancer of unknown primary: from onset of symptoms to initial treatment

Ishida

Ando

Komatsu

et al. 2016

Japanese Journal of Clinical Oncology

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Objective: Supportive care is a critical issue especially for patients with cancer of unknown primary since they often face serious situations, continuing to seek for relevant diagnosis and treatment with the primary sites unknown. However, there are only few research reports on this subject. The aim of this study was to clarify the experience on patients with cancer of unknown primary until they have their initial treatment and to obtain suggestions of supportive care for them. Methods: A qualitative study using semi-structured interviews regarding the experience on patients with cancer of unknown primary was conducted. Results: Data of the experience of the nine patients with cancer of unknown primary until their initial treatment were collected by semi-structured interviews. Patients' speech at interviews recorded in verbatim reports was assigned with 545 codes, 102 subcategories and 38 categories. Experience of the patients with cancer of unknown primary was categorized into five phases: Phase 1: period of making self-judgment on symptoms; Phase 2: period of suspecting serious disease, and seeking for appropriate medical treatment; Phase 3: period of searching for cause of disease while having painful symptoms and anxiety; Phase 4: period of having fear for death, frustration with unknown cause and denial of unknown state; Phase 5: period of struggling but being determined to face disease. Conclusions: Experience of patients with cancer of unknown primary from onset of symptoms to their initial treatment was categorized into five phases, mainly manifesting their psychological burden. These findings will warrant for the future study of supportive care for patients with cancer of unknown primary.

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“…There was also evidence that body mass index was inversely related to CUP with liver metastases which the authors speculated might be due to alcohol abuse. In the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, a total of 651 incident CUP patients were detected [ 24 ]. Risk of being diagnosed with CUP was strongly related to smoking, with a relative risk of 3.66 for current, heavy smokers (26+ cigarettes/day) compared to never smokers.…”

Section: Risk Factorsmentioning

confidence: 99%

“…For alcohol consumption and level of education, weaker associations were observed but they were no longer statistically signifi cant after adjusting for smoking and indices of obesity. The risk of CUP was increased by approximately 30 % for subjects in the highest versus lowest quartiles of waist circumference [ 24 ].…”

Section: Risk Factorsmentioning

confidence: 99%

Epidemiology, Risk Factors, and Survival in CUP: Pointers to Disease Mechanisms

Hemminki

2016

Cancer of Unknown Primary

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Risk factors for cancers of unknown primary site: Results from the prospective EPIC cohort

Cited by 45 publications

References 15 publications

Smoking and body mass index as risk factors for subtypes of cancer of unknown primary

Smoking and body mass index as risk factors for subtypes of cancer of unknown primary

Psychological burden on patients with cancer of unknown primary: from onset of symptoms to initial treatment

Epidemiology, Risk Factors, and Survival in CUP: Pointers to Disease Mechanisms

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