Unknown Primary Tumors: Newer Concepts and Approches “ 10 years experience of a Comprehensive Cancer Center” Valerio Ramazzotti S.C. Epidemiologia Roma.

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Unknown Primary Tumors: Newer Concepts and Approches “ 10 years experience of a Comprehensive Cancer Center” Valerio Ramazzotti S.C. Epidemiologia Roma 05/03/2010

CANCER OF UNKNOWN PRIMARY SITE 1.biopsy - proven malignancy; 2.histology not consistent with a primary tumor at biopsy site; 3.unrevealing history, physical examination and usual examinations 4. failure of additional diagnostic studies to identify primary site Della Porta M.G. Department of Hematology Oncology, University of Pavia Medical School and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy Features:

From: Barry C. Lembersky, MD, and Lisa C. Thomas, MD

Carcinoma of Unknown Primary – Diagnosis by Light Microscopy Well differentiated adenocarcinoma (60%) Squamous cell carcinoma (5%) Poorly differentiated adenoca (15%) Poorly differentiated carcinoma (20%) From: Hainsworth J. Sarah Cannon Research Institute1 and Tennessee Oncology, PLLC,2 Nashville, Tennessee, USA

From: Barry C. Lembersky, MD, and Lisa C. Thomas, MD

Secondary and unspecified malignant neoplasm of lymph nodes ICD9CM CODE: 196 ICD9CM CODE: 197 Secondary malignant neoplasm of respiratory and digestive systems ICD9CM CODE: 198 Secondary malignant neoplasm of other specified sites ICD9CM CODE: 199 Malignant neoplasm without specification of site

It is generally reported that unknown primary tumours account for 5–10% of all neoplasms, and that they tend to have an unfavourable prognosis Unknown Primary Tumours (ICD-O-9 codes 196–199) Survival curves for biopsy-proven (n=543) and clinically diagnosed (n=156) unknown primary malignant tumours: Vaud and Neuchatel, Switzerland, 1984–1993 (1.7%; 2.3% of all sites, excluding 173) From Levi F et al. European Journal of Cancer 38 (2002) 1810–1812

CART generated with the initial split on the presence or absence of liver metastases (default tree) (1000 consecutive patients with UPC) From: K.R. Hess et al. Clinical Cancer Research, Vol. 5,

Kaplan-Meier survival curves of the 10 terminal subgroups generated from the default CART analysis From: K.R. Hess et al. Clinical Cancer Research, Vol. 5,

ICD9CM CODE: 199 Malignant neoplasm without specification of site

ICD9CM CODE: 199 Malignant neoplasm without specification of site ICD9CM CODE: All Malignant Neoplasms

ICD9CM CODE: 199 Malignant neoplasm without specification of site ICD9CM CODE: All Malignant Neoplasms

ICD9CM CODE: 199 Malignant neoplasm without specification of site

ICD9CM CODE: 199 Malignant neoplasm without specification of site

Lazio Region. Unknown Primary Tumours (ICD9 Code 199). N. Admissions by Hospital Typology and Year. (1) Modificata ICD9CM CODE: 199 Malignant neoplasm without specification of site

Lazio Region. Unknown Primary Tumours (ICD9 Code 199). N. Admissions by Hospital Typology and Year. (2) Modificata ICD9CM CODE: 199 Malignant neoplasm without specification of site

ICD9CM CODE: 196 Secondary and unspecified malignant neoplasm of lymph nodes ICD9CM CODE: 197 Secondary malignant neoplasm of respiratory and digestive systems ICD9CM CODE: 198 Secondary malignant neoplasm of other specified sites ICD9CM CODE: 199 Malignant neoplasm without specification of site

ICD9CM CODE: 196 Secondary and unspecified malignant neoplasm of lymph nodes ICD9CM CODE: 197 Secondary malignant neoplasm of respiratory and digestive systems ICD9CM CODE: 198 Secondary malignant neoplasm of other specified sites ICD9CM CODE: 199 Malignant neoplasm without specification of site

ICD9CM CODE: 196 Secondary and unspecified malignant neoplasm of lymph nodes ICD9CM CODE: 197 Secondary malignant neoplasm of respiratory and digestive systems ICD9CM CODE: 198 Secondary malignant neoplasm of other specified sites ICD9CM CODE: 199 Malignant neoplasm without specification of site

ICD9CM CODE: 196 Secondary and unspecified malignant neoplasm of lymph nodes ICD9CM CODE: 197 Secondary malignant neoplasm of respiratory and digestive systems ICD9CM CODE: 198 Secondary malignant neoplasm of other specified sites ICD9CM CODE: 199 Malignant neoplasm without specification of site

ICD9CM CODE: 196 Secondary and unspecified malignant neoplasm of lymph nodes ICD9CM CODE: 197 Secondary malignant neoplasm of respiratory and digestive systems ICD9CM CODE: 198 Secondary malignant neoplasm of other specified sites ICD9CM CODE: 199 Malignant neoplasm without specification of site

CODE: 196 Secondary and unspecified malignant neoplasm of lymph nodes ICD9CM CODE: 197 Secondary malignant neoplaICD9CM sm of respiratory and digestive systems ICD9CM CODE: 198 Secondary malignant neoplasm of other specified sites ICD9CM CODE: 199 Malignant neoplasm without specification of site

IRE. UNKNOWN PRIMARY TUMOURS. FURTHER HOSPITAL ADMISSIONS: ICD9 CODE V58 ICD9CM CODE: V580 Encounter for radiotherapy ICD9CM CODE: V581 Encounter for antineoplastic chemotherapy and immunotherapy

ICD9CM CODE: V580 Encounter for radiotherapy ICD9CM CODE: V581 Encounter for antineoplastic chemotherapy and immunotherapy

Conclusions (1) For unknown primary tumours, hospital discharge data are crucial in clinical care, especially when they are included in the framework of a hospital-based cancer registry (HCR). Even though HCR is not suitable to compute population incidence or prevalence data, it is a valid tool for hospital administration.

Conclusions (2)