ABSTRACT
OBJECTIVE: Decision-making to diagnose an Unknown Primary Cancer (UPC) is subject to great variability. It is possible to design a standard procedure using the scientífic literature, which seems to be able to avoid this variability. We describe the characteristics of the UPC in Asturias and measure the degree of adaptation of the diagnostic decisions to the theoretic standard procedure. METHOD: Descriptive retrospective study (1992-96) RESULTS: A pilot study included 157 cases: mean age 67 years and 59% male. The presentation form most frequent was hepatomegaly (29%) and histology: adenocarcinoma (51%). The diagnosis of the primary was possible in 22%: lung (31%). Median survival: 13 weeks, higher for squamous carcinoma, but independent of the diagnosis of the primary tumour. Comparing with the recommended protocol, the average of unnecessary diagnostic techniques per patient was: 8 analyses, 3 image studies and 0.6 unnecessary aggressive techniques. CONCLUSIONS: The great variability in decision-making for diagnosing advises the application in of a diagnostic protocol that would avoid unnecessary damage for the patient and sanitary costs.
Subject(s)
Adenocarcinoma/secondary , Carcinoma, Squamous Cell/secondary , Carcinoma/secondary , Neoplasms, Unknown Primary , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Neoplasms, Unknown Primary/diagnosis , Neoplasms, Unknown Primary/mortality , Retrospective StudiesABSTRACT
Propósito: La toma de decisiones diagnósticas en el Cáncer de Origen Desconocido (COD) es un arduo problema médico sujeto a gran variabilidad. La protocolización basada en la evidencia científica, podría evitar gestos sanitarios innecesarios y reducir el sufrimiento del enfermo, sin disminución de la supervivencia. Se describen las características clínico-patológicas y epidemiológicas del COD en Asturias, el nivel de adecuación de las decisiones diagnósticas a un protocolo teórico, su repercusión económica y la supervivencia. Método: Estudio descriptivo longitudinal retrospectivo (1992-96) de los casos de COD diagnosticados en los hospitales de Asturias. Resultados: Se incluyeron 568 casos: edad media 66,9 años; 59,7 por ciento varones; 39,3 por ciento estudiado en Servicios de Medicina Interna; 27,1 por ciento con hallazgo del tumor primario (más frecuente, pulmonar); mediana de la supervivencia 13 semanas. El número de técnicas diagnósticas fue variable y la media de estancia hospitalaria, 24,7 días. Un buen ajuste al protocolo se asoció con un número mayor de primarios conocidos. Conclusiones: Existe variabilidad diagnóstica del COD en Asturias. La protocolización podría evitarla en parte y resultaría beneficiosa para el paciente y el sistema sanitario (AU)
Subject(s)
Female , Male , Humans , Neoplasms, Unknown Primary/epidemiology , Spain/epidemiology , Longitudinal Studies , Retrospective Studies , Survival Analysis , Neoplasms, Unknown Primary/economicsABSTRACT
Objetivo: La toma de decisiones diagnósticas en el Cáncer de Origen Desconocido (COD) está sujeta a gran variabilidad. La aplicación de un protocolo diagnóstico basado en la evidencia científica actual, podría evitarla. Se describen las características epidemiológicas del COD en Asturias y se evalúa la adecuación de las pruebas diagnósticas realizadas al protocolo teórico. Método: Estudio descriptivo retrospectivo (1992-96). Resultados: En el estudio piloto se incluyeron 157 casos: 59 por ciento varones, con edad media global de 67 años. La forma de presentación más frecuente fue hepatomegalia (29 por ciento) y la histología: adenocarcinoma (51 por ciento). El diagnóstico del primario se hizo en el 22 por ciento, localizándose en pulmón en el 31 por ciento; se hizo necropsia sólo en el 4,8 por ciento de los fallecidos. La mediana de la supervivencia fue de 13 semanas, significativamente superior para el carcinoma escamoso, sin relación con el éxito en el diagnóstico del primario. La media de estudios innecesarios por paciente fue de: 8 analíticas, 3 técnicas de imagen y 0,6 técnicas agresivas. El desvío respecto del protocolo teórico fue superior al 25 por ciento en un 47 por ciento de los casos. Conclusiones: La aplicación de un protocolo diagnóstico en el estudio del COD evitaría pruebas diagnósticas innecesarias, con el consiguiente ahorro de molestias para el paciente y de costes sanitarios (AU)
Objective: Decision-making to diagnose an Unknown Primary Cancer (UPC) is subject to great variability. It is possible to design a standard procedure using the scientífic literature, wich seems to be able to avoid this variability. We describe the characteristics of the UPC in Asturias and measure the degree of adaptation of the diagnostic decisions to the theoretic standard procedure. Method: Descriptive retrospective study (1992-96). Results: A pilot study included 157 cases: mean age 67 years and 59% male. The presentation form most frecuent was hepatomegaly (29%) and histology: adenocarcinoma (51%). The diagnosis of the primary was possible in 22%: lung (31%). Median survival: 13 weeks, higher for squamous carcinoma, but independent of the diagnosis of the primary tumour. Comparing with the recommended protocol, the average of unnecessary diagnostic techniques per patient was: 8 analyses, 3 image studies and 0,6 unnecesary aggresive techniques. Conclusions: The great variability in decision-making for diagnosing advises the application of a diagnostic protocol that would avoid innecesary damage for the patient and sanitary costs (AU)
Subject(s)
Middle Aged , Adult , Aged , Aged, 80 and over , Male , Female , Humans , Neoplasms, Unknown Primary , Retrospective Studies , Carcinoma , Carcinoma, Squamous Cell , AdenocarcinomaABSTRACT
OBJECTIVE: To describe uncommon forms of dissemination of hypernephroma. METHODS: A case of hypernephroma that metastasized to the laryngeal vallecula and bronchi is presented. Our findings were compared with those reported in the literature. The diagnostic, radiological, clinical aspects and route of dissemination of some atypical sites of metastasis are discussed. RESULTS/CONCLUSIONS: It is important to be familiar with these atypical sites of metastasis since these lesions may appear at the same time or before the primary tumor is detected. A high index of suspicion will make a major impact on treatment and prognosis. The radiological findings are undoubtedly of enormous value, although histological confirmation is necessary in order to make the correct diagnosis.
Subject(s)
Bronchial Neoplasms/secondary , Carcinoma, Renal Cell/secondary , Kidney Neoplasms/pathology , Laryngeal Neoplasms/secondary , Adrenal Gland Neoplasms/secondary , Bronchial Neoplasms/diagnostic imaging , Carcinoma, Renal Cell/diagnostic imaging , Humans , Laryngeal Neoplasms/diagnostic imaging , Male , Tomography, X-Ray ComputedABSTRACT
The unknown primary cancer is a hazardous diagnostic and limited therapeutic medical problem with too much variability. It is possible to design a standard procedure using the world-wide scientific literature, which could be able to decrease patient suffering and to avoid unnecessary sanitary costs, without diminishing survival. First of all we have conducted a retrospective descriptive study including all the patients with unknown primary neoplasms detected in our Internal Medicine service during 1994. We have met 18 cases, most of them adenocarcinoma and undifferentiated carcinoma, and hepatomegaly as clinical presentation. In 8 cases (44%) was the primary tumour site identified, mainly with CT. Only 3 (16%) patients were alive at the end of the study, with a mean survival of 5 months. The mean stay and time until diagnosis were 16.5 and 21.5 days respectively. Further studies will let us to asses the effectiveness of a theoretic diagnostic protocol.
