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  [ close window ] email this please enter a recipient address and/or check the send me a copy checkbox. Your email has been sent. Your name:  copy me on this email () recipient's email:  separate multiple email addresses with commas (limit is 10). Subject:  optional message:  visit this blog's front page lab line by the doctor’s doctor carcinoma unknown primary site (cups) and molecular testing thomas wheeler, md, pathology, 06:44pm feb 4, 2011 one of the great conundrums in clinical oncology is the patient that presents with metastatic carcinoma where the primary is not evident.   it may be surprising, but in 10-20% of these patients (in the pre-molecular and pre-immunohistochemistry era) the primary site could not be pinpointed with certainly, even after a complete autopsy. In the modern era the figure is closer to 3-5%.   this is not at all an unusual problem, in that cups is the seventh most common category of cancer. In recent years proprietary molecular tests have been developed to aid in pinpointing the tissue of origin for metastatic poorly differentiated carcinomas.   typically such tests are not utilized unless standard imaging and immunohistochemistry panels fail to determine the primary site.   these molecular profiles are not cheap and may cost up to $3,000.   this seems quite expensive when, in most cases, the average survival after diagnosis is measured in months.   admittedly, this may not be the case for certain types of cancers that have specific types of endocrine therapy (e. G. Prostate and breast), targeted radiation therapy (thyroid with radioactive iodine) or exquisite sensitivity to certain classes of chemotherapy (e. G. Germ cell tumors).   however, it should be noted that in most instances of these specific examples, the primary site can be determined with standard immunohistochemistry panels. One of our oncologists is quite keen on these new molecular tests for primary site determination in cups.   although his practice is in the county hospital for indigent patients (this expense is born solely by the tax payers), his justification is that it is much cheaper to do this test than it costs for multiple radiologic scans and/or endoscopies (not including the cost of the extra stay in the hospital).   does it really make a difference if the cancer began in the stomach or in the pancreas?   in this era of getting the most benefit out of our health care dollar, does it make sense to widely apply this type of testing?   what is your experience? Poll. viagra discount order generic viagra discounted viagra viagra online without prescription viagra for sale no rx viagra cheap do i need prescription to buy viagra in canada buy viagra online buy generic viagra canada buy viagra online canada    
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