tailieunhanh - Chapter 095. Carcinoma of Unknown Primary (Part 5)

Treatment algorithm for tomography; chemotherapy. PET, positron squamous cell CUP. tomography; RT, CT, computed radiation; C, emission Treatment of Favorable Subsets of CUP Women with Isolated Axillary Adenopathy Women with isolated axillary adenopathy with adenocarcinoma or carcinoma should be treated for stage II or III breast cancer. These patients should undergo a breast MRI if mammogram and ultrasound are negative. Radiation therapy to the ipsilateral breast is indicated if the breast MRI is positive. Chemotherapy and/or hormonal therapy is indicated based on patient's age (premenopausal or postmenopausal), nodal disease bulk, and hormone receptor status (Chap. 86). . | Chapter 095. Carcinoma of Unknown Primary Part 5 Figure 95-3 Treatment algorithm for squamous cell CUP. CT computed tomography PET positron emission tomography RT radiation C chemotherapy. Treatment of Favorable Subsets of CUP Women with Isolated Axillary Adenopathy Women with isolated axillary adenopathy with adenocarcinoma or carcinoma should be treated for stage II or III breast cancer. These patients should undergo a breast MRI if mammogram and ultrasound are negative. Radiation therapy to the ipsilateral breast is indicated if the breast MRI is positive. Chemotherapy and or hormonal therapy is indicated based on patient s age premenopausal or postmenopausal nodal disease bulk and hormone receptor status Chap. 86 . Women with Peritoneal Carcinomatosis The term primary peritoneal papillary serous carcinoma PPSC has been used to describe CUP with carcinomatosis with the pathologic and laboratory elevated CA-125 antigen characteristics of ovarian cancer but no ovarian primary tumor identified on transvaginal sonography or laparotomy. Studies suggest that ovarian cancer and PPSC which are both of mullerian origin have similar gene expression profiles. Similar to patients with ovarian cancer patients with PPSC are candidates for cytoreductive surgery followed by adjuvant taxane and platinum-based chemotherapy. In one retrospective study of 258 women with peritoneal carcinomatosis who had undergone cytoreductive surgery and chemotherapy 22 of patients had a complete response to chemotherapy the median survival duration was 18 months range 11-24 months . Poorly Differentiated Carcinoma with Midline Adenopathy Men with poorly differentiated or undifferentiated carcinoma that presents as a midline adenopathy should be evaluated for extragonadal germ cell malignancy. They often experience a good response to treatment with platinumbased combination chemotherapy. Response rates of 50 have been noted and 10-15 long-term survivors have been reported. Neuroendocrine Carcinoma