Adenocarcinoma of unknown primary site

A retrospective review of 108 patients with adenocarcinoma of unknown primary site (ACUPS) seen at Charleston Area Medical Center from 1979 to 1987 was performed. The liver and bones were the most common presenting sites of metastases. Only three patients had their primary site found after extensive radiologic and endoscopic workup. The pancreas and biliary tract were the most frequent laparotomy or autopsy-proven primary sites. Four of the 27 patients treated with chemotherapy responded (14.8 per cent). Eleven of 12 patients who survived for longer than 12 months had predominantly localized disease which permitted local therapy (i.e. surgery and/or radiotherapy). The median survival of the entire cohort was four months. The search for the primary site should include investigation of the patients' signs and symptoms, and limited screening tests.