Unknown primary

For high-perfomance status patients of unknown primary, non-toxic chemotherapeutic combinations may play an important role in palliation and even survival. A review of 220 patients with poorly differentiated neoplasms by Hainsworth et al. [87] demonstrated a major tumor response in 62% of patients treated with a combination of chemotherapy, including cisplatin, etoposide, and bleomycin. If no response is observed after one or two courses, therapy should be discontinued and alternate approaches considered. If complete response is obtained, radiotherapy of involved nodal basins should be also considered for further local control. The minority of patients who present with clinically favorable disease, such as women with primary peritoneal carcinomatosis or isolated axillary lymphadenopathy, or those whose tissue histology suggests responsiveness to chemotherapeutic or even surgical intervention, should be treated accordingly. Chemotherapy, radiotherapy, and surgery all play integral roles in the treatment of these patients. The promise of long-term survival or even curative resection demonstrates the  importance of a thorough and appropriate clinical evaluation. A few malignancies are as anxiety provoking as the cancer of unknown primary site. Often, the primary physician is bereft of a standard diagnostic and therapeutic protocol, as modern oncologic management is dependent on identification of a primary tumor. In addition, significant confusion and frustration occurs at the patient level over failure to identify the primary. The final goal in the treatment of patients with unknown primary cancers will be the development and utilization of new trials to determine the optimal combination of multimodal therapies in responsive subsets. This includes the use of newer chemotherapeutic agents, surgical techniques, and more advanced molecular characterization of the tumor.