Treatments for specific subsets of patients with CUP

Histologic type	Clinical feature	Treatment recommendation
Adenocarcinoma	Females with isolated axillary adenopathy	Treat as stage II breast cancer
	Females with peritoneal carcinomatosis	Treat as stage III ovarian cancer
	Males with elevated PSA or blastic bone metastases	Treat as advanced prostate cancer
	Colon cancer profile	Treat as advanced colon cancer
	NSCLC profile	Treat as advanced NSCLC
	RCC profile	Treat as advanced RCC
	Thyroid carcinoma profile	Treat as advanced follicular/papillary thyroid carcinoma
Adenocarcinoma or PDC	Single metastatic lesion	Definitive local therapy (resection and/or radiation therapy)
Squamous cell carcinoma	Cervical adenopathy	Treat as head and neck cancer with involved neck nodes
	Inguinal adenopathy	Inguinal node dissection
		Consider concurrent radiation therapy/chemotherapy (as in locally advanced cervical or anal cancer)
Poorly differentiated carcinoma	Young males with midline tumor or elevated hCG/AFP	Treat as extragonadal germ cell tumor
Poorly differentiated neuroendocrine carcinoma	Diverse clinical presentations	Treat with platinum/etoposide or paclitaxel/platinum/etoposide

Approximately 40% of patients with carcinoma of unknown primary (CUP) fit into one of these subsets with specific treatment implications.

PSA: prostate-specific antigen; NSCLC: non-small cell lung cancer; RCC: renal cell carcinoma; PDC: poorly differentiated carcinoma; hCG: human chorionic gonadotropin; AFP: alpha-fetoprotein.

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Treatments for specific subsets of patients with CUP