Clinical Case Database / Category: Case Based Discussion

Managing a patient with carcinoma of unknown primary

Publication details

P J Gomes, C Chinyama
Foundation Years Journal, volume 6, issue 9, p.14 (123Doc Education, London, October 2012)


A 67 year old man presented with fatigue, mild dyspnoea and an aching lower back and rib cage. He was found to have diffusely abnormal bones on imaging and further investigation demonstrated adenocarcinoma of unknown primary site (1). This case-based discussion describes the process of investigation and management of this patient, some unusual features of his case and potential complications of treatment. He remains well more than two years after diagnosis.

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P J Gomes

Consultant Medical Oncologist
Princess Elizabeth Hospital

C Chinyama

Consultant Histopathologist
Princess Elizabeth Hospital


1. Metastatic carcinoma with unknown primary site. Updated January 2012
2. Chu P, Wu E and M Weiss L. Cytokeratin 7 and Cytokeratin 20 Expression in Epithelial Neoplasms: A Survey of 435 Cases . Mod Pathol 2000;13(9):962–972.
3. NICE Guidance 2010. Diagnosis and management of metastatic malignancy of unknown primary origin. live/13044/49864/49864.pdf
4. Massaud C, Loriot Y, Fizazi K. Carcinomas of an unknown primary origin – diagnosis and treatment. Nat Rev Clin Oncol 2011;8(12):701-710.


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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.