Table 2 Evaluation, clinical course and survival of patients
Evaluation for primary focus | Final decision for primary focus | Clinical course/Management | Survival | |
|---|---|---|---|---|
1 | Chest XR, abdominopelvic USG and transrectal USG: N; CEA and CA15.3 are high slightly and Ca19.9 is high more than 10 folds, among CEA, α FTP, PAP, CA-125, CA19.9, CA15.3 | GI tractus | General condition deteriorated rapidly; stupor and coma developed/Supportive care; 2 courses of TPE | 6 days |
2 | Chest XR, abdominopelvic USG and CT: N; gastroscopy: malign ulcus | Stomach | DIC, subdural hematoma developed/Multiple erythrocyte, platelet and plasma transfusions; 2 courses of TPE | 11 days |
3 | Abdominopelvic USG and CT: thickness on the antrum wall, gastrohepatic and portahepatic microLAPs; only α-FTP is in normal limits, among the CEA, α-FTP, CA 125, CA15.5; CA19.9 is high more than 10 folds; gastroscopy: infiltration in corpus and antrum (linitis plastica) | Stomach | DIC diagnosed at admission. Hematemesis and epistaxis developed later/Despite full transfusion support; died due to intracerebral bleeding | 20 days |
4 | Chest XR, mammography: N; abdominopelvic USG and CT: N except minimal free pelvic fluid; upper GI tract endoscopy: unremarkable | TUO | Fever resisted despite AB; general condition deteriorated gradually, generalized seizures developed without abnormal cranial CT finding; hypoxemia developed due to secretions/Supportive care only | 12 days |
5 | Chest XR: N; abdominopelvic CT: not optimal; suspected thickness on the stomach wall, suspected metastatic lesions in columna vertabralis; upper GI tract endoscopy: malign ulcus in cardia; CA125 is high slightly and CA-19-9 is high approximately 6 times, among CEA, α-FTP, Ca 125, CA 19-9, CA 15-3 | Stomach | AB resistant fever (FUO) and GI tract bleeding developed later/Despite full transfusion support her general condition deteriorated rapidly. Died in MODS picture | 37 days |
6 | Cranial CT: N; thorax, abdomen and pelvis MR: multiple mediastinal LAPs in conglemeration with suspected parenchimal infiltration, benign prostate hyperthrophy; lumbar MR: multiple pathologic signal in backbone and degenerative alterations; Skeleton scintigraphy: multiple thoracal and lumbar uptake (degeneration, metastasis, trauma?) | Lung? | His consciousness impaired progressively; refractory fever and hypotension developed | 5 days |
7 | Thorax, abdominal CT: subcarinal LAPs, a mass in right hilus, eosophagial compression, pulmonary artery and pericardium invasion, a hipodens lesion in 1 cm diameter in liver (USG in terminal period: multiple lesions compatible with metastasis); bronchoscopy: inoperable bronchial carcinoma; biopsy: small cell carcinoma); upper GI tract endoscopy: N. CEA, α-FTP, PSA, freePSA, CA125, CA 19.9 all: N | Lung | Pneumonia and atrial fibrillation developed/A course of CT (Etoposide+Cisplatine) was given. Died duo to CHF | 47 days |
8 | Axillary node FNAB: benign; cranial MR: compatible with bone metastasis and leptomeningeal carcinomatosis; thorax CT: only bone metastasis; abdominopelvic CT: 3 mm hipodens lesion in liver (metastasis?), backbone metastasis; transvaginal USG: N; bone scintigraphy: multiple metastasis; mammography: N; whole spine MR: generalized sclerotic and lytic lesions; upper GI tract endoscopy: erythemateous gastritis; only CA 125 is high 2 folds, among CEA, α-FTP, CA 125, CA 19-9, CA15-3, BHCG | TUO | Performance status deteriorated gradually. GI tract bleeding developed/She refused colonoscopy and other supportive therapies and was discharged in very bad condition | 38+ days |
9 | Chest XR: N; transrectal USG: prostate carcinoma?; prostate biopsy: adenocarcinoma; skelatal XR survey: multiple sclerotic metastasis and compression fracture in L3; bone scintigraphy: generalized metastatic involvement; tumor markers: PSA and free PSA are very high | Prostate | After his work up bisphosphonates therapy was initiated and was fallowed as outpatient; cranial metastasis developed later; despite progressive complaints he refused admission | 7+ months |
10 | Abdominopelvic CT: a solid mass in the pelvis originated probably right gluteal muscle and homogeneous hepatosplenomegaly; biopsy from the mass: rhabdomyosarcoma; skelatal XR survey: lytic lesions in only pelvic bones and proximal femur; bone scintigraphy: pathologic uptake in bilateral knee, pelvic area and, 5. and 7. ribs | Muscle | VAC/IE (Vincristine, Adriamycine, Cyclophosphomide, Ifosfamide, etoposide) therapy resulted in partial response; died because of progression later | 7 months |
11 | Chest XR: N; abdominopelvic US: N except homogen minimal hepatomegaly | GI system? | His general condition deteriorated rapidly; GI tract bleeding and subdural hematoma developed, Died because of herniation/Supportive care only | 10 days |
12 | Abdominopelvic CT: normal except suspected rigidity in stomach wall; gastroscopy: malign ulcus in junction of corpus and fundus; biopsy: Adenocarcinoma; Mammography: N; Backbone XR: loss of height in Th11 and Th12 | Stomach | One course 5FU+FA was given; died as out patient | 1 month |
13 | Nasopharynx biopsy: N; pleural fluid cytology: negative, biopsy: nonspecific chronic pleuritis; mammography:N; bone scintigraphy: multiple uptake; colonoscopy: N; gastroscopy: N; CEA and CA15.3: N, CA19.9 and CA125: very high | GI system | Transfusion support. Lost to follow up | 45+ days |
14 | Chest XR and abdominopelvic USG: N | TUO | Nothing. Out of follow in 2nd week | 14 days |
15 | Chest XR: nondiagnostic; CEA, α-FTP, PSA, free PSA, CA15.3, Ca19.9, Ca125 all: N | TUO | Despite vigorous transfusion support and antibiotics his vital functions deteriorated progressively and died in MODS | 4 days |
16 | Chest XR: nondiagnostic; previous available tests: thorax CT: linear atelectasis and minimal right pleural fluid, 1–2 cm multiple mediastinal LAPs;.abdominal CT: homogeneous hepatomegaly and multiple cysts in 1.5 cm diameter in head of pancreas | TUO | She died because of hypertensive crises and CHF after admission | 1 day |
17 | Pelvic and transrectal USG: Prostatic hypertrophy; prostate biopsy: Adenocarcinoma; thoracolumbar MR and bone scintigraphy: multiple bone metastasis in backbone | Prostate | Flutamide (antiandrogen) and Goserelin asetat (LH-LR analogue) were given. Paraparesis and paraplegia unresponsive to RT developed and died because of progressive disease and CHF | 15 months |
18 | Neck and thorax CT: N; abdominopelvic CT: paraaortic 1.5 cm LAPs and heterogen prostatic hypertrophy, prostate biopsy: Adenocarcinoma; pelvis XR: multiple sclerotic lesions; bone scintigraphy; multiple + focuses in whole skeleton: PAP and PAS: very high; CEA, AFP, CA19.9: N | Prostate | Gaserolin asetat+ Bikalutamid (LH-RH analogues) were given; (he was in a good condition when writing) | 3+ months |
19 | Bone scintigraphy: multiple + uptake; gastroscopy: malign ulcus; biopsy: signet cell carcinoma (antrum); CEA, CA 19.9: very high, Ca125: high, AFP, PSA, F-PSA:N; thoracal MR: loss of height in Th8; toraks CT: frosted glass appearance in lower and middle zones, minimal pleural effusion bilaterally; abdominopelvic CT:N; skelatal XR: Lumbar and pelvic sclerotic lesions | Stomach | Supportive care and palliative RT were given; he died because of progressive disease | 51 days |