Occult Primary

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Occult primary tumors, or cancers of unknown primary, account for 5% to 10% of all diagnosed cancers, and are manifested by a wide variety of clinical presentations, while conferring a poor prognosis for most patients. Even after postmortem examination, the primary tumor is not identified in 20% to 50% of patients. Multiple sites of involvement are observed in more than 50% of patients. Although certain patterns of metastases suggest possible primaries, occult primaries can metastasize to any site. In most patients, occult primary tumors are refractory to systemic treatments, and chemotherapy is only palliative and does not significantly improve long-term survival. However, special pathologic studies can identify subsets of patients with tumor types that are more responsive. Treatment options should be individualized for this selected group to achieve improved response and survival rates. Important updates for the NCCN guidelines include the additions of tables on tumor-specific markers and their staining pattern as well as analysis of undifferentiated carcinoma.

For the most recent version of the guidelines, please visit NCCN.org

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Vanderbilt-Ingram Cancer Center (www.vicc.org or 800-811-8480), based in Nashville, Tennessee, is one of a select few National Cancer Institute–designated Comprehensive Cancer Centers in the southeastern United States and the only one in Tennessee that conducts research and provides clinical care for the full range of cancers in adults and children.

Established in 1993, Vanderbilt-Ingram brings together the cancer-related research, clinical care, education, prevention, and outreach activities at Vanderbilt University and Medical Center. Its nearly 300 faculty members in 7 research programs generate more than $140 million in total federal grant support. In 2007, Vanderbilt-Ingram ranked seventh in the nation in competitive grant funding from the National Cancer Institute ($66 million).

The center focuses its efforts on high-impact basic and translational research and high-quality multidisciplinary care, with particularly strong programs in experimental therapeutics and lung, gastrointestinal, breast, head and neck, melanoma, pediatric, and hematologic malignancies. Its 3 Specialized Programs of Research Excellence (in lung, gastrointestinal, and breast cancers) have recently been renewed with review scores among the best in the country. The center is also known for its population-based research program, particularly the Southern Community Cohort Study, a historic initiative that is on track to enroll 90,000 residents of the Southeast, two-thirds of them African American, with a goal of understanding and addressing why southerners and African Americans face a greater burden from cancer than other groups.

Led by Jennifer Pietenpol, PhD (second photo on the cover), as its director, Vanderbilt-Ingram is a major cancer referral center for the southeast, with more than 4,000 new cancer patients entered into its cancer registry each year. Its Henry-Joyce Cancer Clinic is undergoing a major renovation and expansion that will double the outpatient capacity when completed in late 2009. Its Breast Center will expand early in 2009 with a new facility as part of Vanderbilt Health One Hundred Oaks, which is transforming Nashville's first enclosed shopping mall into a state-of-the-art health and wellness center (see www.vanderbilthealth.com/100oaks).

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