不明原发灶肿瘤的诊断2-ed.ppt

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1、MetastaticCancerUnknownPrimarySite中国医学院肿瘤医院内科王宏羽MetastaticCancerUnknownPrimarySiteSynonymsandrelatedkeywords◆tumorofunknownprimary◆cancerofunknownorigin◆carcinomaofunknownorigin◆unknownprimarycancerMetastaticCancerUnknownPrimarySite◆unknownprimarycarcino

2、ma◆carcinomaofunknownprimaryoriginMetastaticCancerUnknownPrimarySite◆cancerofunknownprimarysite(cups)◆carcinomaofunknownprimaryorigin(CUP)MetastaticCancerUnknownPrimarySite◆metastaticcancer◆metastaticcarcinoma◆metastatictumor◆metastases◆occultprimarymali

3、gnancyCUPBackground(intheUnitedStates)◆32,100patswithCUPSin2007(15,720males;16,380females)◆About2%ofallcancersCUP◆DeathsduetoCUPS:45,230(24,440males;20,790females)CUP◆Thisdiscrepancybetweenincidenceandmortalityisbelievedtobeduetoalackofspecificityinthelist

4、ingof causeofdeathondeathcertificatesCUP◆Itstrueincidenceismostprobablybetween2%and6%◆In15-25%ofcases,theprimarysitecannotbeidentifiedevenonpostmortemCUPPathophysiology◆Cancersarethoughttoarisefromasinglecellthatescapesthecontrolsofnormalcellreplication◆Fo

5、rmsatumoratthesiteoforigin◆UltimatelymetastasizestootherorgansCUPPathophysiology◆Insomecasestheoriginaltumormayremainsmallorundetectableatthetimeofmetastasis◆LeadingtotheclinicalpresentationofCUPCUPFrequency◆UnitedStates:2-6%◆International:2-9%CUPMortality

6、/Morbidity◆Mediansurvival rangesfrom11weeksto11months◆The5-yearoverallsurvivalrateisabout11%CUPSex◆AnapproximateequalincidenceformenandwomenCUPAge◆Themedianageonpresentationforbothmenandwomenrangesfrom59-66yearsCUPCLINICAL(History)◆Becausemostpatientswithc

7、uphavefairlyadvanced-stagedcancers◆Theconstitutionalsymptomsofmalaise,weakness,fatigue,andweightlossarepresentinnearlyallpatientsCUPCLINICAL(Physical)◆Theclinicalpresentationofcupisextremelyvariable◆DependsontheextentandtypeoforganinvolvementCUP◆一群异源发生的肿瘤◆

8、除外淋巴瘤、转移性黑色素瘤和转移性肉瘤◆集中于上皮细胞组织，包括腺癌、鳞状上皮细胞癌、分化不良上皮癌和神经内分泌癌CUPCUP的诊断标准◆组织活检证实为恶性肿瘤(活检部位不能检出原发灶)◆经过彻底地收集病史或物理检查(包括女性盆腔检查和男性睾丸及前列腺触诊)未发现原发性肿瘤CUP◆CUP实验室检查结果正常，包括完整的血细胞计数、血液生化、胸部X线、腹部和盆腔CT、乳房影像学检查或前列腺特异性抗原(PSA)检查等等