Empiric chemotherapy in patients with carcinoma of unknown primary site
Article Abstract:
In 10 percent of cancers, the primary site of the cancer is not known. This makes it extremely difficult to determine the most effective combination of anti-cancer or chemotherapeutic agents for the treatment of the cancer. Because a physician must use his past experience with chemotherapeutic agents rather than complete knowledge of the nature of the cancer, the treatment is called empiric. In addition, in such cases of carcinoma of unknown primary site (CUP), treatment is directed towards affecting the whole body rather than specific sites, and hence is called systemic. The clinical and pathologic evaluation of a patient with CUP will help to identify which patients are more likely to respond to systemic therapy. Examination of the patient's tissue may indicate a tumor type known to be responsive to systemic therapy, such as tumors of the prostate, lymphatic system, and neuroendocrine tissues. Clinical evaluation helps to identify characteristics in patients who would be responsive to systemic therapy, such as features common to germ cell tumor syndrome. For patients who do not fit these categories, only 30 percent of cases respond to chemotherapy and these patients survive less than a year. Although a superior combination of chemotherapeutic agents is not known, doxorubicin and mitomycin C are effective in 25 percent of patients but have serious side effects, particularly in the blood. Better diagnostic techniques and methods of clinical and pathologic evaluation are needed to identify patients with CUP that will respond to systemic chemotherapy.
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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HTLV-I-associated adult T-cell leukemia/lymphoma presenting with nodular synovial masses
Article Abstract:
A case is described of a 40-year-old man with a nine-month history of adenopathy (disease of the lymph nodes), night sweats, fever, weight loss, and periarticular nodules (cell masses in the areas surrounding the joints). The patient was not homosexual and did not use intravenous drugs. A biopsy from the right wrist revealed a lymphocytic lymphoma, a malignant tumor of the lymphatic tissue. The patient had swollen lymph nodes in the neck, underarm, and groin regions, and nodules surrounding joints of the elbows, wrists, knees, and fingers. He was treated with the anticancer agents, cyclophosphamide, doxorubicin, vincristine, and the steroid prednisone, but the nodules continued to enlarge, causing pain and limiting motion in the joints. The patient was initially diagnosed with T-cell lymphoma, a type of lymphoid tissue tumor. However, the persistence of nodules surrounding the joints following anticancer therapy is unusual for most forms of lymphoma. A diagnosis of human T-cell leukemia virus (HTLV)-1-associated adult T-cell leukemia/lymphoma (ATLL) was considered because of the patient's Jamaican ancestry. The prolonged clinical course and other signs including normal calcium and liver function tests did not support this diagnosis. However, a diagnosis of HTLV-1-associated ATLL was confirmed by genetic and immunological tests. This case of HTLV-1-associated ATLL was unusual in that the disease was primarily localized in the membrane lining the joints. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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