is there a generic brand of viagra Journal of clinical oncology skip to main page content search go advanced search â» user name password sign in home search browse by topic archive early release podcasts meeting abstracts resources alerts advertisement â© 2008 by american society of clinical oncology raising the profile of cancer of unknown primary karin a. Oien and t. R. Jeffry evans division of cancer sciences and molecular pathology; cancer research uk beatson laboratories, university of glasgow, glasgow, united kingdom despite recent advances in clinical cancer medicine, metastatic cancer of unknown primary site (cup) remains a major challenge. Some 10% to 15% of cancer patients present with metastases, and the site of origin may not be initially apparent. In one third of these patients (approximately 4% of all cancers), even after extensive evaluation, no primary tumor is identified and they are designated as having cup. 1 cup comprises a range of cancer types and subtypes. Lymphoma, leukemia, melanoma, germ cell tumor, and sarcoma are usually excluded. Thus, cup translates to carcinoma of unknown primary, of which 90% are adenocarcinomas or poorly differentiated carcinomas, 5% are squamous carcinomas and 5% are neuroendocrine carcinomas. buying generic viagra viagra sales in uk buy cheap viagra canada viagra cheap pills cheap viagra for sale generic viagra without presciption usa buy viagra online buy real viagra online cheapest generic viagra 2 among the adenocarcinomas, the most common primary sites at autopsy are lung and pancreas (both comprising approximately 25%), 2,3 followed by colon and stomach, then breast, ovary, prostate and the solid-organ carcinomas of kidney, thyroid, and liver. Identification of the likely primary site may significantly influence optimal patient management. A number of therapeutic advances, including therapies targeted to specific pathways, may be applicable not only for breast and prostate cancers but also for gi cancers, especially colorectal. Diagnostic work-up includes clinical assessment, computed tomography scans of chest, abdomen, and pelvis, and targeted evaluation of any specific signs or symptoms. 1 cup is defined as the lack of any detectable primary site after full evaluation. Biopsy of the metastasis establishes a diagnosis of malignancy and of the broad tumor type. However, it is not easy to specify the primary origin of an adenocarcinoma on routine hematoxylin and eosin staining. A number of differentiation-associated genes have emerged and entered clinical use during the last decade as markers for immunohistochemistry (ihc), detecting proteins such as ck7, ck20, psa, er, and ttf1,.


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