Unknown primary – part 1


        UNKNOWN PRIMARY – PART 1
So far in this chapter we have considered the approach when we start from the primary cancer. What happens when we have to deal with the reverse situation? It is not unusual for the first indication of the presence of cancer to be in the form of secondary growths. For example, the chest X-ray of a person who complains of coughing blood may show a number of small secondary cancer deposits. A person who has slipped over and broken the thigh bone may be found to have a secondary cancer spot at the site of the fracture. Nausea, loss of weight and upper abdominal discomfort may lead to the diagnosis of secondary cancer in the liver. In such cases we have to work backwards taking clues from the secondary deposits to help in our search for the primary cancer.
The same basic considerations apply here—tests should only be considered if the result would make a difference to the person's care. We must consider whether knowing where the primary cancer is will make any difference to treatment. Local forms of treatment aimed at eradicating the cancer are clearly out when there are already secondary growths. Forms of treatment which go right through the body (chemotherapy, hormone therapy, etc) may be useful for certain particular types of cancer, so it is worth searching for these types (see later chapters). If symptomatic treatment only is being considered, there is no point in searching for a primary cancer that is not causing any symptoms. We can wait for the symptoms and deal with them if and when they develop.
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Cancer
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