Metastatic Adenocarcinoma From An Unrecognized Primary Tumor

Metastatic adenocarcinoma without demonstration of the primary tumour was diagnosed within a period of 42 months in 13 women and 11 men, median age 68.5 years. Analysis of initial symptoms, cardinal findings on first examination and pathological laboratory values pointed predominantly to a primary site in the abdomen. The following conclusions were drawn from this study, with all the disadvantages of retrospective analysis: in a majority of patients (14) the tumour mass could be localized in the upper abdomen. Primary sites include pancreas, biliary tract and gallbladder and possibly colon in the differential diagnosis. There is usually not a good response to chemotherapy. On the other hand, it is important to examine all organs for possible primary site of a carcinoma the metastases of which can be successfully treated by chemotherapy or hormones (mammary, ovarian, testicular, thyroid and prostate carcinoma). Taking into account a median survival time of 28 weeks and the fact that 73% of all technical investigations were normal, diagnostic measures should be as few as possible, restricted predominantly to clinical and biochemical ones, radiography of the thorax, abdominal ultrasound, digital pelvic examination, mammography, and serological and cytological tumour parameters.