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1、不明(b mn)原发灶肿瘤的诊断详解演示文稿1页，共128页，星期一。（优选）不明(b mn)原发灶肿瘤的诊断2页，共128页，星期一。3页，共128页，星期一。4页，共128页，星期一。5页，共128页，星期一。6页，共128页，星期一。7页，共128页，星期一。8页，共128页，星期一。9页，共128页，星期一。CUPPathophysiologyCancersarethoughttoarisefromasinglecellthatescapesthecontrolsofnormalcellreplicationFormsatumoratthesiteoforiginUltimatelym
2、etastasizestootherorgans10页，共128页，星期一。CUP PathophysiologyInsomecasestheoriginaltumormayremainsmallorundetectableatthetimeofmetastasisLeadingtotheclinicalpresentationofCUP11页，共128页，星期一。CUPFrequency UnitedStates:2-6%International:2-9%12页，共128页，星期一。CUPMortality/MorbidityMediansurvivalrangesfrom11weekst
3、o11monthsThe5-yearoverallsurvivalrateisabout11%13页，共128页，星期一。CUPSexAnapproximateequalincidenceformenandwomen14页，共128页，星期一。CUP AgeThemedianageonpresentationforbothmenandwomenrangesfrom59-66years15页，共128页，星期一。CUP CLINICAL(History)Becausemostpatientswithcuphavefairlyadvanced-stagedcancersTheconstitutio
4、nalsymptomsofmalaise, weakness, fatigue, and weight lossarepresentinnearlyallpatients 16页，共128页，星期一。 CUPCLINICAL(Physical) TheclinicalpresentationofcupisextremelyvariableDependsontheextentandtypeoforganinvolvement17页，共128页，星期一。CUP 一群异源发生的肿瘤一群异源发生的肿瘤除除外外(chwi)(chwi)淋淋巴巴瘤瘤、转转移移性性黑黑色色素素瘤瘤和和转转移移 性肉瘤性肉瘤
5、集中于上皮细胞组织，包括腺癌、鳞集中于上皮细胞组织，包括腺癌、鳞 状上皮细胞癌、分化不良上皮癌和神状上皮细胞癌、分化不良上皮癌和神 经内分泌癌经内分泌癌18页，共128页，星期一。CUP CUPCUP的诊断标准的诊断标准组织活检证实为恶性肿瘤组织活检证实为恶性肿瘤( xng zhng li)( xng zhng li)( (活活检部位不能检出原发灶检部位不能检出原发灶) )经过彻底地收集病史或物理检查经过彻底地收集病史或物理检查( (包括女包括女性盆腔检查和男性睾丸及前列腺触诊性盆腔检查和男性睾丸及前列腺触诊) )未未发现原发性肿瘤发现原发性肿瘤19页，共128页，星期一。CUP CUPCUP
6、实验室检查结果正常，包括完整实验室检查结果正常，包括完整(wnzhng)(wnzhng)的血细胞计数、血液生化、胸部的血细胞计数、血液生化、胸部X X线、腹部和盆腔线、腹部和盆腔CTCT、乳房影像学检查或、乳房影像学检查或前列腺特异性抗原前列腺特异性抗原(PSA)(PSA)检查等等检查等等20页，共128页，星期一。CUPCLINICAL完整的病史和彻底的体格检查是诊断完整的病史和彻底的体格检查是诊断CUPCUP的基本前提，尤其是既往组织活检结果的基本前提，尤其是既往组织活检结果家族史很可能提示家族史很可能提示(tsh)(tsh)遗传性非息肉病性遗传性非息肉病性结肠癌或乳腺癌易感性结肠癌或乳腺
7、癌易感性21页，共128页，星期一。CUP彻底的体检可能会发现特异性原发肿瘤彻底的体检可能会发现特异性原发肿瘤左侧锁骨上淋巴结肿大左侧锁骨上淋巴结肿大(VirehowS(VirehowS结节结节)()(胃胃Ca?)Ca?)脐周淋巴结肿大或包块脐周淋巴结肿大或包块(Sister Mary JosphS(Sister Mary JosphS结节结节- -由恶性腹水造成的腹胀以及由恶性腹水造成的腹胀以及(yj)(yj)脐周肿块脐周肿块 脐孔肿大变脐孔肿大变硬硬, ,产生冰山样脐部肿块产生冰山样脐部肿块)()(低分化癌低分化癌- -胃肠道胃肠道) )腹股沟淋巴结肿大、肛周包块腹股沟淋巴结肿大、肛周包块
8、( (肛门肿瘤肛门肿瘤) ) 22页，共128页，星期一。 CUPCLINICAL(Physical)Themostcommonsitesofinvolvementbeinglung, bone, lymph nodes, and liver23页，共128页，星期一。CUPCLINICAL(Physical)Includinghead and neck, rectal, testicular, pelvic, and breastexaminations24页，共128页，星期一。CUPCLINICAL(Physical, Lab and radiological studies)Acomp
9、letebloodcellcount(irondeficiencymaypointtowardanoccultgastrointestinalmalignancyleadingtochronicbloodloss)25页，共128页，星期一。CUPCLINICAL(Physical, Lab and radiological studies)urinalysis(microscopichematuriamaybeasignofoccultgenitourinarymalignancy)26页，共128页，星期一。CUPCLINICAL(Physical, Lab and radiologica
10、l studies) liverandrenalfunctiontestsstoolforoccultbloodchestradiograph27页，共128页，星期一。CUPCLINICAL(Physical, Lab and radiological studies)abdomenandpelvisCTmammographyinwomenmeasurementofPSAinmen28页，共128页，星期一。CUP PhysicalAscitesshouldleadonetoevaluateforaGIoranovarianprimaryAn axillary massinafemalesh
11、ouldmakethecliniciancheckforbreastcancerA cervical nodeshouldleadtoathoroughENTexamination29页，共128页，星期一。CUP PhysicalA brain metastasisshouldleadtoasearchforalung, breast, or kidneyprimaryBone metastasisshouldleadtoevaluationforprostate, breast, lung, renal, or thyroidprimary30页，共128页，星期一。CUP Physica
12、lA testicular massshouldleadtomeasurementoftumormarkerssuchasbeta-HCGandAFP31页，共128页，星期一。CUPPhysicalDependingontheclinicalsituation,thesemayincludechestCT,breastMRI,upperorlowerendoscopy32页，共128页，星期一。CUPCLINICAL(Physical)Insuspectedheadandneckmalignancies,panendoscopyoftheupperaerodigestivepathwayss
13、houldbeperformedwithevenasindicatedblindbiopsiesofthelymphoidtissueintheseareas33页，共128页，星期一。CUPCLINICAL(Physical) Diagnostictonsillectomymaybewarranted34页，共128页，星期一。CUPCLINICAL(Physical)Intensivetestingalsoaddstothemorbidityfortheweakandfrailpatient35页，共128页，星期一。CUPCLINICAL(Physical) Alargenegative
14、cost-to-benefitratioexistsforanextensiveunguidedclinicalevaluation36页，共128页，星期一。CUPCLINICAL(Physical) Onestudyquotinga9.5%increasein1-yearsurvivalatacostof2-8milliondollars37页，共128页，星期一。CUPCLINICAL(Physical)Whentheseinvestigationsfailtorevealapotentialprimarylesion,acancerofunknownprimaryoriginisass
15、umed38页，共128页，星期一。CUPWORKUP(Imaging Studies)18F-FDG-PETisincreasinglybeingusedintheevaluationofmetastaticmalignancies39页，共128页，星期一。CUPWORKUP(Imaging Studies)Thismaybeespeciallythecaseinsuspectedheadandneckmalignancies40页，共128页，星期一。CUPWORKUP(Imaging Studies)Thistestinglacksspecificityandmayonlybeusef
16、ultoidentifypromisingsitesforbiopsy41页，共128页，星期一。CUPWORKUP(Imaging Studies)1818氟氟- -脱氧葡萄糖脱氧葡萄糖( (1818F-FDG)-PETF-FDG)-PET可辅助可辅助指导活组织检查指导活组织检查(jinch)(jinch)，确定疾病程度和，确定疾病程度和辅助选择恰当的治疗辅助选择恰当的治疗42页，共128页，星期一。CUPWORKUP(Imaging Studies)Althoughpromising,highcostandfalsepositiveratesof20%limititsutilityincasesofCUPThecombinationofPET/CTmayreducethefalse-positiverate43页，共128页，星期一。CUPOther TestsTheroleoftumormarkerslikeAFP,beta-HCG,CA125,CA27.29,CA19.9,andCEAtoestablishaspecificprimarysite44页，共128页，星期一。CU
