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==Overview==
==Overview==
Colorectal cancer is the third most commonly diagnosed [[cancer]] in the world, and accounts for 8% of all cancer-related deaths annually. There are both [[genetic]] and [[Environmental epidemiology|environmental]] factors that can increase the risk of colorectal carcinoma (CRC). The pathogenesis of colorectal carcinoma (CRC) involves the molecular pathways for both sporadic and [[Colitis|colitis-associated CRC]]. There are both [[genetic]] and [[Environmental epidemiology|environmental]] causes of colorectal carcinoma (CRC). Colorectal cancer may be differentiated from other diseases that cause unexplained [[weight loss]], unexplained [[loss of appetite]], [[nausea]], [[vomiting]], [[diarrhea]], [[anemia]], [[jaundice]], and [[fatigue]], such as [[irritable bowel syndrome]] (IBS), [[inflammatory bowel disease]] (IBD), [[hemorrhoids]], [[anal fissures]], and [[diverticular disease]]. Current guidelines recommend that [[colonoscopy]] is the optimal screening tool for colon cancer since it detects 98-99% of the cases. The progression from an [[Polyp|edematous polyp]] to colorectal cancer may take 10-15 years. Colorectal cancer staging is an estimate of the amount of penetration of the cancer. Staging is based on the [[TNM classification|TNM classification system]] which depends on the extent of local invasion, the degree of [[Lymph node metastases|lymph node]] involvement, and whether there is distant [[metastasis]]. The history of a patient with colorectal cancer may include a family history of [[polyps]]/colorectal cancer or a history of [[inflammatory bowel disease]]. Some symptoms that are associated with colorectal cancer are change in bowel habits, [[hematochezia]], and [[rectal pain]]. [[Metastatic]] symptoms include [[dyspnea]], [[abdominal pain]], [[fractures]], and [[confusion]]. Generally, the most common signs of colorectal cancer are [[emaciation]], [[lethargy]], and [[pallor]] Other signs include [[low-grade fever]], discomfort on [[palpation]], [[ascites]], [[rectal bleeding]], [[rectal mass]], and [[jaundice]]. The laboratory findings associated with colorectal carcinoma are the following: [[Complete Blood Count]] ([[Complete blood count|CBC]]), [[Fecal Occult Blood Test|Fecal Occult Blood Tests]] ([[FOBT]]), [[CEA|serum CEA]] and [[CA 19-9|CA 19-9 concentration]], [[Serum iron|serum iron concentrations]], [[Vitamin B12|serum vitamin B12]] and [[folate]] concentrations, [[liver function tests]], and [[pulmonary function tests]]. [[Chest radiography]] (CXR) is the initial imaging modality used in the detection of suspected [[pulmonary metastasis]]. [[CT scan]] is used to determine the extent of involvement on colon cancer, most commonly in the [[abdomen]] and [[lungs]]. Other imaging tests that can be used for colorectal cancer are [[MRI]], [[ultrasound]], [[endoscopy]], [[PET scan]], [[Barium swallow|barium study]], and [[angiography]]. A [[biopsy]] and [[genetic testing]] can be performed when a suspected lesion is found on [[colonoscopy]]. [[Chemotherapy]] is used to reduce the likelihood of [[metastasis]] developing, shrink tumor size, and slow tumor growth. [[Surgery]] remains the primary treatment while [[chemotherapy]] and/or [[radiotherapy]] may be recommended depending on the individual patient's staging and other medical factors. When colorectal cancer metastasizes, there will be a different approach than with a localized tumor. The most common site of metastasis is the [[liver]], and the second most common is the [[lung]].  
'''Cancer of unknown primary origin''' or CUP is the diagnosis of [[Metastasis|metastatic]] [[cancer]] when the anatomic site of origin remains unidentified. Cancer of unknown primary origin is common, and it accounts for 2–5% of all cancers. Cancer of unknown primary origin may be classified according to [[pathology]] findings into 4 groups: [[adenocarcinomas]], poorly differentiated [[carcinomas]], [[Squamous cell carcinoma|squamous cell carcinomas]], and [[Carcinoma|carcinomas]] with [[Neuroendocrine tumors|neuroendocrine]] differentiation. The majority of patients with cancer of unknown primary origin may be initially [[asymptomatic]]. Early clinical features include [[fatigue]], [[weight-loss]], and [[loss of appetite]]. If left untreated, the majority of patients with cancer of unknown primary origin may progress to develop [[multiple organ failure]], [[heart failure]], and death. The treatment for cancer of unknown primary origin will depend on several factors, such as: metastatic origin, [[biopsy]] findings, patients age, and performance status. The 5-year survival of patients with cancer of unknown primary origin is less than 2%.
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==Historical Perspective==
==Historical Perspective==

Revision as of 20:04, 9 February 2019

Cancer of unknown primary origin Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: ; Roukoz A. Karam, M.D.[2]

Overview

Cancer of unknown primary origin or CUP is the diagnosis of metastatic cancer when the anatomic site of origin remains unidentified. Cancer of unknown primary origin is common, and it accounts for 2–5% of all cancers. Cancer of unknown primary origin may be classified according to pathology findings into 4 groups: adenocarcinomas, poorly differentiated carcinomas, squamous cell carcinomas, and carcinomas with neuroendocrine differentiation. The majority of patients with cancer of unknown primary origin may be initially asymptomatic. Early clinical features include fatigue, weight-loss, and loss of appetite. If left untreated, the majority of patients with cancer of unknown primary origin may progress to develop multiple organ failure, heart failure, and death. The treatment for cancer of unknown primary origin will depend on several factors, such as: metastatic origin, biopsy findings, patients age, and performance status. The 5-year survival of patients with cancer of unknown primary origin is less than 2%.

Historical Perspective

Pathophysiology

Causes

Differential Diagnosis

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Staging

History and Symptoms

Physical Examination

Diagnostic Studies

Laboratory Findings

X-Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Medical Therapy

Surgery

Metastases Treatment

Primary Prevention

Secondary Prevention

References


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