General
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- In 5% of patients presenting with metastatic cancer the site
of origin is never established. Prognosis is generally poor. It
is very difficult to anticipate the rate of disease progression
and therefore to advise patients and their carers about symptoms
and mode of deterioration that might occur.
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- It can be difficult to know how aggressively to pursue the primary
cancer site. Cancers that respond to oncological intervention
such as breast, thyroid, lymphoma, ovary and testicular should
be considered.
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- Anxiety is common in this group of patients. Not knowing the
site of the primary tumour causes considerable distress. Extensive
investigations may raise false expectations and may exhaust the
patient. Equally patients and carers may feel cheated of the chance
to have effective treatment if the primary is not looked for.
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- Carers may find coming to terms with the patient’s death
difficult and are at greater risk of an adverse bereavement reaction.
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Key Points |
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- Risk of over investigation
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- Adverse bereavement reaction
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