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MUO approach Dr. Salma Elashwah Lecturer of Medical Oncology, Mansours University, Egypt. Agenda: Definition & Epidemiology. Clinical characteristic at presentation. Major sites of MUO at initial presentation. Diagnostic approach: Treatment. Definition & epidemiology : MUO is a clinica...

MUO approach Dr. Salma Elashwah Lecturer of Medical Oncology, Mansours University, Egypt. Agenda: Definition & Epidemiology. Clinical characteristic at presentation. Major sites of MUO at initial presentation. Diagnostic approach: Treatment. Definition & epidemiology : MUO is a clinical disorder where a patient presents with histologically confirmed metastatic cancer for which standard diagnostic investigations failed to identify the primary site. Accounts for 2-9% of all human cancers. It is considered to be the 7th-8th most frequent malignant tumor. Clinical characteristic at presentation: Average age at diagnosis of 60 to 75 years. These heterogeneous tumors have a wide variety of clinical presentations: Absence of the primary, Early dissemination, Aggressiveness, and Unpredictability of metastatic pattern. About 80% of patients with MUO have a poor prognosis and median overall survival (OS) of 3 to 10 months. Major sites of MUO at initial presentation: Diagnostic approach: a complete history taking, detailed review of past biopsies or malignancies, removed lesions; physical examination (including breast, genitourinary, pelvic, and rectal examinations); Routine laboratory tests (ie, complete blood count [CBC], electrolytes, liver function tests, creatinine, calcium), occult blood stool testing. Tumor markers (CA15-3, PSA). Diagnostic approach: By imaging: Computerized tomography (CT) is the most frequently used imaging modality in the management of patients with MUO. Magnetic resonance imaging (MRI). Breast Ultrasound & MAMOGRAPHY. positron emission tomography (PET) scan and a computed tomography (CT): (PET/CT): when radical therapy for local disease is planed. Lung metastasis Liver metastasis By histopathology: Carcinoma (adenocarcinoma, squamous CK (cytokeratin) carcinoma) Lymphoma LCA (LEUCOCYTE COMMON ANTIGEN) Melanoma S100, HMB45 Sarcoma VIMENTINE, S100  Concept: By Molecular Neoplasm retains gene expression profile based on cellular analysis: origin; this profile can be exploited to identify tumor type. By Endoscopy: Should always be symptoms guided investigational approach. Treatment: Primary found: Treat as disease guidelines. MUO: TREATMENT: Favorable prognosis treatment Isolated inguinal adenopathy (SCC): local excision +/- radiotherapy. Woman with adenocarcinoma involve axillary managed as breast cancer. lymph node: Woman with papillary adenocarcinoma of managed as ovarian cancer. peritoneal cavity: Adenocarcinoma with colon profile (presented managed as colon cancer. with abdominal LN, peritoneal nodules, liver metastasis, ascites): Men with bone metastasis from adenocarcinoma managed as prostate cancer. with elevated PSA: TREATMENT: Unfavorable prognosis Treatment Male gender, older age (≥65 years), Multiple comorbidities, Metastases involving multiple organs Treated with empirical chemotherapy ± (eg, liver, lung, bone); radiotherapy Peritoneal metastases; multiple cerebral metastases; Non-papillary malignant ascites (adenocarcinoma); PRINCIPLES OF RADIATION THERAPY: Consider adjuvant radiation therapy after lymph node dissection (if the disease is limited to a single nodal site). Consider palliative radiotherapy for symptomatic patients: uncontrolled pain, impending pathologic fracture, or impending cord compression. TO SUMMERISE: Thank you