Web Exclusive: Find a Clinical Trial That's Right for You
July 09, 2009
Web Exclusive: Find a Clinical Trial That's Right for You
July 09, 2009
Web Exclusive: A Q&A with an Extraordinary Healer
June 30, 2009 – Kathy LaTour
Web Exclusive: Types of Kidney Cancer
June 25, 2009 – The American Cancer Society
Web Exclusive: Helpful Advice
June 25, 2009 – Elizabeth Whittington
Web Exclusive: Developing a Strategy
June 25, 2009 – Elizabeth Whittington
Web Exclusive: Searching for New Targets
June 23, 2009 – Elizabeth Whittington
Web Exclusive: When Survivors Should Exercise Caution
June 22, 2009 – Lena Huang
Web Exclusive: Fertility Guidelines Not Meeting Needs of Patients
June 22, 2009 – Elizabeth Whittington
Web Exclusive: A Peaceful Spirit
June 18, 2009 – Toby Bressler, RN, BSN, OCN
Web Exclusive: The Voice on the Other End of the Phone
June 18, 2009 – Dianne Ericson
Excerpt: Stronger
June 17, 2009 – Natalie Flechsig
Web Exclusive: An Infection Out of Nowhere
June 16, 2009
Web Exclusive: Solving a Medical Mystery
June 16, 2009 – Debu Tripathy, MD
Web Exclusive: Clinical Trials for CUP
June 16, 2009
Childhood Cancer Survivorship Programs
June 16, 2009
Chicken Soup for the Soul: The Cancer Book
June 15, 2009 – Kathy LaTour
Improved Care Needed for Patients Receiving Heart-Toxic Drugs
June 15, 2009 – Melissa Weber
Cancer Research Receives Infusion of Federal Funds
June 15, 2009 – Lacey Meyer
Resources
June 09, 2009
P.S. A Word About Implants & Some Unanswered Questions
June 09, 2009 – Kathy LaTour
How to Find a Cancer Trainer
June 09, 2009 – Lena Huang
Smarter Trials for Smarter Drugs
June 09, 2009 – Laura Beil
Sticker Shock
June 09, 2009 – Laura Beil
Resources
June 09, 2009
From Cancer Warrior to Basketball Player
June 09, 2009 – Deirdre Carey
Taking a Closer Look
June 09, 2009 – Karen Patterson
Surgical Strategies
June 09, 2009 – Karen Patterson
Hair Loss Snapshot
June 09, 2009 – Lacey Meyer
Weighing the Techniques
June 09, 2009 – Charlotte Huff
What About CUP Patients?
June 09, 2009 – Katy Human
Hard Times
June 09, 2009 – Joanne Kenen
Reconstruction Do-Overs
June 09, 2009 – Kathy LaTour
Fighting Fatigue
June 09, 2009 – Lena Huang
Disjointed Custody
June 09, 2009 – Charlotte Huff
No I.D.
June 09, 2009 – Katy Human
ASCO Updates
June 09, 2009 – Staff Reports
Interventions Needed to Get Survivors Moving
June 09, 2009 – Lena Huang
The Financial Advocate
June 09, 2009 – Kathy LaTour
Ovarian Cancer Survivors Course
June 09, 2009
Q & A: Prostate Cancer Screening
June 09, 2009 – Len Lichtenfeld, MD
www.armyofwomen.org
June 09, 2009 – Elizabeth Whittington
With a Friend Like Will Ferrell...
June 09, 2009 – Lacey Meyer
Program Keeps Tabs on Childhood Cancer Survivors
June 09, 2009 – Lacey Meyer
Revisiting the Seasons of Survival
June 09, 2009 – Kenneth D. Miller, MD
Prostate, Brain & Kidney Cancers
June 09, 2009 – Elizabeth Whittington
A Life Beyond Cancer
June 09, 2009 – Renée La Forest
Good Grilling
June 09, 2009 – Lena Huang
Medical Devices Face Stricter Regulations
June 09, 2009 – Jo Cavallo
All Is Not Lost
June 09, 2009 – Lacey Meyer
Letters from Our Readers
June 09, 2009
Message from the Editor
June 09, 2009 – Debu Tripathy, MD
Targeted Therapy: Hope or Hype?
June 09, 2009 – Laura Beil
Conquering Cancer & the Classroom
June 09, 2009 – Scott Williams
Reining in Renal Cancer
June 09, 2009 – Karen Patterson
Web Exclusive: Find a Clinical Trial That's Right for You
July 09, 2009
Web Exclusive: Find a Clinical Trial That's Right for You
July 09, 2009
Web Exclusive: A Q&A with an Extraordinary Healer
June 30, 2009 – Kathy LaTour
Web Exclusive: Types of Kidney Cancer
June 25, 2009 – The American Cancer Society
Web Exclusive: Helpful Advice
June 25, 2009 – Elizabeth Whittington
Web Exclusive: Developing a Strategy
June 25, 2009 – Elizabeth Whittington
Web Exclusive: Searching for New Targets
June 23, 2009 – Elizabeth Whittington
Web Exclusive: When Survivors Should Exercise Caution
June 22, 2009 – Lena Huang
Web Exclusive: Fertility Guidelines Not Meeting Needs of Patients
June 22, 2009 – Elizabeth Whittington
Web Exclusive: A Peaceful Spirit
June 18, 2009 – Toby Bressler, RN, BSN, OCN
Web Exclusive: The Voice on the Other End of the Phone
June 18, 2009 – Dianne Ericson
Excerpt: Stronger
June 17, 2009 – Natalie Flechsig
Web Exclusive: An Infection Out of Nowhere
June 16, 2009
Currently Viewing
Web Exclusive: Solving a Medical Mystery
June 16, 2009 – Debu Tripathy, MD
Childhood Cancer Survivorship Programs
June 16, 2009
Chicken Soup for the Soul: The Cancer Book
June 15, 2009 – Kathy LaTour
Improved Care Needed for Patients Receiving Heart-Toxic Drugs
June 15, 2009 – Melissa Weber
Cancer Research Receives Infusion of Federal Funds
June 15, 2009 – Lacey Meyer
Resources
June 09, 2009
P.S. A Word About Implants & Some Unanswered Questions
June 09, 2009 – Kathy LaTour
How to Find a Cancer Trainer
June 09, 2009 – Lena Huang
Smarter Trials for Smarter Drugs
June 09, 2009 – Laura Beil
Sticker Shock
June 09, 2009 – Laura Beil
Resources
June 09, 2009
From Cancer Warrior to Basketball Player
June 09, 2009 – Deirdre Carey
Taking a Closer Look
June 09, 2009 – Karen Patterson
Surgical Strategies
June 09, 2009 – Karen Patterson
Hair Loss Snapshot
June 09, 2009 – Lacey Meyer
Weighing the Techniques
June 09, 2009 – Charlotte Huff
What About CUP Patients?
June 09, 2009 – Katy Human
Hard Times
June 09, 2009 – Joanne Kenen
Reconstruction Do-Overs
June 09, 2009 – Kathy LaTour
Fighting Fatigue
June 09, 2009 – Lena Huang
Disjointed Custody
June 09, 2009 – Charlotte Huff
No I.D.
June 09, 2009 – Katy Human
ASCO Updates
June 09, 2009 – Staff Reports
Interventions Needed to Get Survivors Moving
June 09, 2009 – Lena Huang
The Financial Advocate
June 09, 2009 – Kathy LaTour
Ovarian Cancer Survivors Course
June 09, 2009
Q & A: Prostate Cancer Screening
June 09, 2009 – Len Lichtenfeld, MD
www.armyofwomen.org
June 09, 2009 – Elizabeth Whittington
With a Friend Like Will Ferrell...
June 09, 2009 – Lacey Meyer
Program Keeps Tabs on Childhood Cancer Survivors
June 09, 2009 – Lacey Meyer
Revisiting the Seasons of Survival
June 09, 2009 – Kenneth D. Miller, MD
Prostate, Brain & Kidney Cancers
June 09, 2009 – Elizabeth Whittington
A Life Beyond Cancer
June 09, 2009 – Renée La Forest
Good Grilling
June 09, 2009 – Lena Huang
Medical Devices Face Stricter Regulations
June 09, 2009 – Jo Cavallo
All Is Not Lost
June 09, 2009 – Lacey Meyer
Letters from Our Readers
June 09, 2009
Message from the Editor
June 09, 2009 – Debu Tripathy, MD
Targeted Therapy: Hope or Hype?
June 09, 2009 – Laura Beil
Conquering Cancer & the Classroom
June 09, 2009 – Scott Williams
Reining in Renal Cancer
June 09, 2009 – Karen Patterson

Web Exclusive: Solving a Medical Mystery

Cancer is usually not an emergency, so days or even weeks should be taken to answer the question as best possible. 

BY Debu Tripathy, MD
PUBLISHED June 16, 2009

During medical school and residency, I was always fascinated by medical mysteries and the exercise of problem-solving. This is, of course, a routine part of medical education, and most of us take pride in getting the correct diagnosis in a very difficult test case.

But in real life, the correct diagnosis may be elusive. This can be frightening when the “unknown” is the origin of cancer that has spread. When I first heard the term “cancer of unknown primary,” or CUP, I found it hard to believe this could end up being the final “answer,” despite following the accepted guidelines for diagnostic tests and having expert oncologists, radiologists, and pathologists on the case.

What are the oncologist and patient to do for a case of CUP? How can a reasonable diagnostic and treatment plan be put together in a reasonable timeframe? Cancer is usually not an emergency, so days or even weeks should be taken to answer the question as best possible. The oncologist must also get a sense of the tempo of the cancer—how fast is it growing, what are the current symptoms, and what is the best sequence of tests. Sometimes, therapy might need to be initiated before the answer is clear, especially in a patient who is acutely ill due to their cancer.

These days, sophisticated imaging tests and expert pathology review, special tumor immunostains and even DNA-based tests like chromosomal studies and FISH (fluorescent in situ hybridization) can be done within a few days if an expert team is assembled quickly. 

The first set of tests should be to determine whether this could be a more treatable and responsive tumor, like germ cell tumors (including testicular cancer) or high-grade lymphoma. If enough evidence emerges to classify these, potentially curative therapy can be started.

Clinical data such as the age of the patient, symptoms, location of the metastases, and blood tests should steer the team as to the best order of test—younger patients with midline tumors are more likely to have more treatable cancers like germ cell tumors.

Older patients with tumors that resemble those that arise in glands (carcinomas) probably have one of the more common and less responsive cancers such as breast, prostate, colon, or lung cancers. However, they can still respond, especially if they have some of the known targets, such as hormonal therapies for estrogen, progesterone, or androgen receptors, or Herceptin (trastuzumab) if the HER2 gene is amplified or overexpressed. The key is to have the right team, a clear plan, and some degree of patience—in many cases, the last of these is the hardest. 

Continue the conversation on CURE’s forum. >>
Talk about this article with other patients, caregivers, and advocates in the CURE discussion group.

Related Articles

1
×

Sign In

Not a member? Sign up now!
×

Sign Up

Are you a member? Please Log In