TY  - CHAP
M1  - Book, Section
TI  - Carcinoma of Unknown Primary in a Patient with Multiple Comorbidities
A1  - Thillai, Kiruthikah
A1  - Simms, Jacqueline
A1  - Rudman, Sarah
A1  - Birns, Jonathan
A2  - Ring, Alistair
A2  - Harari, Danielle
A2  - Kalsi, Tania
A2  - Mansi, Janine
A2  - Selby, Peter
PY  - 2018
T2  - Problem Solving in Older Cancer Patients
AB  - An  85-year-old  woman  with  hypertension,  ischaemic  heart  disease  and  chronic  kidney  disease  presented  with  a  6  month  history  of  anorexia,  malaise  and  weight  loss.  She  was  compliant  with  antiplatelet  and  antihypertensive  medications.  She  lived  alone,  spending  most  of  the  day  resting,  and  required  a  twice-daily  carer  to  help  her  wash  and  dress.  Physical  examination  revealed  hepatomegaly.  Serum  haematology  and  biochemistry  showed  normocytic  anaemia  (Hb  8.2  g/dl  [normal  range  11.5-16.5]);  raised  aspartate  transaminase  (262  IU/l  [normal  range  0-37]);  raised  creatinine  (200  mol/l  [normal  range  45-84]);  and  an  estimated  glomerular  filtration  rate  21  ml/min  (normal  range  70-130)  (similar  to  that  measured  1  year  previously).  Abdominal  ultrasound  revealed  a  solitary  liver  lesion  in  segment  VII  measuring  4.2×3.7  cm,  indicating  a  possible  metastasis.  Subsequent  CT  scanning  confirmed  three  further  bilobar  metastatic  lesions  and  multiple  enlarged  abdominal  lymph  nodes.  Histology  from  an  ultrasound-guided  liver  biopsy  confirmed  a  poorly  differentiated  adenocarcinoma  that  stained  positive  for  cytokeratin  (CK)  7  and  negative  for  CK20  and  oestrogen  receptor  (ER).  No  primary  tumour  was  identified  on  imaging.  Comprehensive  Geriatric  Assessment  (CGA)  helped  to  determine  optimal  management  strategies  for  her  new  oncological  diagnosis,  comorbidities  and  frailty.  Supportive  care  was  recommended  in  view  of  the  unfavourable  risk-benefit  profile  of  systemic  anticancer  treatment.  Her  fatigue,  social  isolation  and  declining  functional  independence  was  managed  with  four-times-daily  carer  input,  a  'meals-on-wheels'  service  and  community-based  palliative  care.What  are  the  guidelines  and  evidence  for  investigating  patients  with  metastatic  disease  of  unknown  primary?What  are  the  considerations  when  investigating  a  frail  older  patient  with  suspected  cancer  of  unknown  primary  (CUP)?How  can  prognosis  be  assessed  in  this  patient?What  evidence-based  treatment  options  are  available  for  this  patient?What  are  the  realistic  goals  for  this  patient?How  may  CGA  help  identify  and  implement  best  supportive  care  for  this  patient?  
SN  - 
PB  - Clinical Publishing
CY  - New York, NY
Y2  - 2021/03/09
UR  - hemonc.mhmedical.com/content.aspx?aid=1152358334
ER  -