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Viszeralchirurgie 2004; 39(5): 364-368
DOI: 10.1055/s-2004-820422
Originalarbeit

© Georg Thieme Verlag Stuttgart · New York

Das CUP-Syndrom: Diagnostik und Therapie

CUP-Syndrome: Diagnostic and TherapyM. K. Angele1 , K. W. Jauch1
  • 1Chirurgische Klinik und Poliklinik, Klinikum Großhadern, Ludwig-Maximilians Universität, München
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Publication History

Publication Date:
29 September 2004 (online)

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Zusammenfassung

Cancer of Unkown Primary (CUP)-Syndrom beschreibt den histologischen Nachweis von Metastasen ohne das gleichzeitige Auffinden eines Primärtumors. Der Begriff CUP ist ein Oberbegriff für viele verschiedene Krebsarten. Somit sind Heilungschancen (Prognose) und Behandlungsart für jeden Patienten anders, je nachdem welche Krebsart bei ihm tatsächlich vorliegt. Spezielle histologische Untersuchungsmethoden wie z. B. immunhistochemische Untersuchungen und moderne Röntgendiagnostik, wie z. B. Positron Emission Tomography (PET) haben die Diagnostik bei Patienten mit CUP-Syndrom verbessert. Der Primärtumor bleibt dennoch beim größten Teil der Patienten selbst nach Autopsie unbekannt. Eine kleine Gruppe dieser Patienten weisen eine relativ gute Ansprechrate auf systemische Chemotherapie in Kombination mit lokoregionäre Therapieverfahren auf. Beim größten Teil der Patienten kann durch Therapiemaßnahmen keine Lebensverlängerung erreicht werden. Aus diesem Grund muss sowohl bei der Diagnostik als auch der gewählten Therapie die Lebensqualität und die zu erwartende Lebenserwartung des Patienten berücksichtigt werden. Zusammenfassend bedarf die Diagnostik und Behandlung des CUP-Syndroms der intensiven, interdisziplinären Zusammenarbeit der Inneren Medizin, Chirurgie, Pathologie, Strahlentherapie, ggf. Urologie, Gynäkologie und Hals-, Nasen-, Ohrenheilkunde. Möglicherweise kann in der Zukunft durch die Verwendung von molekularbiologischen und immunologischen Methoden die Diagnostik und Therapie des CUP-Syndroms verbessert und dadurch das Überleben dieser Patienten verlängert werden.

Abstract

Metastatic Cancer of Unknown Primary Site (CUP) accounts for approximately 3 % of all malignant neoplasms. In those patients the site of origin for the metastatic disease cannot be identified at the time of diagnosis. It is now accepted that CUP represents a heterogeneous group of malignancies that share a unique clinical behaviour and, presumably, unique biology. Specific histological examinations, i. e. immunohistochemistry and modern imaging technology, i. e. high-resolution computed tomography, Positron Emission Tomography (PET) scan, have resulted in some improvements in diagnosis; however, the primary site remains unknown in most patients, even following autopsy. A small group of patients with CUP syndrome have been identified, which are responsive to systemic chemotherapy and/or locoregional treatment. Identification and treatment of these patients is of paramount importance. For patients who do not fit into any favourable sub-set treatment strategies should focus on life quality. In summary, diagnosis and treatment of patients with CUP syndrome require an interdisciplinary corporation involving disciplines, i. e. internal medicine, surgery, pathology, radiology etc. In the future novel therapeutic approaches including immunotherapy and molecularbiology-based methods might improve diagnosis of primary and improve survival in those patients.

Schlüsselwörter

Cancer of Unknown Primary - Diagnostik - Therapie - Metastasen

Key words

Cancer of Unknown Primary - Diagnosis - Therapy - Metastasis

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Prof. Dr. med. K. W. Jauch

Chirurgische Klinik und Poliklinik · Klinikum Großhadern · Ludwig-Maximilians Universität

Marchioninistr. 15

81377 München

Phone: 0 89-70 95-27 90

Fax: 0 89-70 95-56 74

Email: Karl-Walter.Jauch@med.uni-muenchen.de