Skip to main content
SpringerLink
Log in

CUP-Syndrom im Halsbereich

Cervical CUP syndrome

  • Leitthema
  • Published:
Der Radiologe Aims and scope Submit manuscript

Zusammenfassung

Unter dem Begriff CUP-Syndrom („cancer of unknown primary“) versteht man ein vielgestaltiges Krankheitsbild, bei dem die betroffenen Patienten Lymphknoten- und/oder Fernmetastasen aufweisen, ohne dass die Lokalisation des Primärtumors bekannt ist. Die Kriterien des CUP-Syndroms sind erfüllt, wenn ein histologisch oder zytologisch gesichertes Malignom vorliegt ohne nachweisbaren Primärtumor nach Abschluss der Primärdiagnostik. Aufgrund der meist schlechten Prognose und dem mannigfaltigen Erscheinungsbild, welches eine standardisierte Therapie oft nicht ermöglicht, stellt das zervikale CUP-Syndrom spezifische Anforderungen an die klinische und bildgebende Diagnostik. Die Bildgebung nimmt hierbei mittels moderner Techniken wie Positronen-Emissions-Tomographie/Computertomographie (PET/CT) eine Schlüsselrolle bei der Detektion eines möglichen, okkulten Primärtumors sowie im Rahmen des Stagings und der Prognoseeinschätzung ein.

Abstract

The term CUP syndrome (cancer of unknown primary) refers to a multifaceted clinical picture in which the affected patients have lymph node and/or distant metastases without the location of the primary tumor being known. The criteria of CUP syndrome are fulfilled if a histologically or cytologically confirmed malignancy is present without a detectable primary tumor after completion of the primary diagnosis. Due to the usually poor prognosis and the manifold appearance, which often does not allow a standardized therapy, cervical CUP syndrome makes specific demands on clinical and imaging diagnostics. Using modern techniques such as positron emission tomography-computed tomography (PET-CT), imaging plays a key role in the detection of a possible occult primary tumor as well as in staging and prognosis assessment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Antoch G (2003) Whole-body dual-modality PET/CT and whole-body MRI for tumor staging in oncology. JAMA 290:3199. https://doi.org/10.1001/jama.290.24.3199

    Article  CAS  PubMed  Google Scholar 

  2. Bochtler T, Krämer A (2019) Does cancer of unknown primary (CUP) truly exist as a distinct cancer entity? Front Oncol 9:402. https://doi.org/10.3389/fonc.2019.00402

    Article  PubMed  Google Scholar 

  3. van den Brekel MW, Stel HV, Castelijns JA et al (1990) Cervical lymph node metastasis: assessment of radiologic criteria. Radiology 177:379–384. https://doi.org/10.1148/radiology.177.2.2217772

    Article  PubMed  Google Scholar 

  4. Burglin SA, Hess S, Høilund-Carlsen PF, Gerke O (2017) 18F-FDG PET/CT for detection of the primary tumor in adults with extracervical metastases from cancer of unknown primary: a systematic review and meta-analysis. Medicine 96:e6713. https://doi.org/10.1097/MD.0000000000006713

    Article  CAS  PubMed  Google Scholar 

  5. Chung MS, Choi YJ, Kim SO et al (2019) A scoring system for prediction of cervical lymph node metastasis in patients with head and neck squamous cell carcinoma. AJNR Am J Neuroradiol 40:1049–1054. https://doi.org/10.3174/ajnr.A6066

    Article  CAS  PubMed  Google Scholar 

  6. Cianchetti M, Mancuso AA, Amdur RJ et al (2009) Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site. Laryngoscope 119:2348–2354. https://doi.org/10.1002/lary.20638

    Article  PubMed  Google Scholar 

  7. Galloway TJ, Ridge JA (2015) Management of squamous cancer metastatic to cervical nodes with an unknown primary site. J Clin Oncol 33:3328–3337. https://doi.org/10.1200/JCO.2015.61.0063

    Article  CAS  PubMed  Google Scholar 

  8. Giovagnorio F, Caiazzo R, Avitto A (1997) Evaluation of vascular patterns of cervical lymph nodes with power Doppler sonography. J Clin Ultrasound 25:71–76. https://doi.org/10.1002/(sici)1097-0096(199702)25:2<71::aid-jcu4>3.0.co;2-g

    Article  CAS  PubMed  Google Scholar 

  9. Hemminki K, Chen B, Melander O et al (2015) Smoking and body mass index as risk factors for subtypes of cancer of unknown primary: risk factors of CUP. Int J Cancer 136:246–247. https://doi.org/10.1002/ijc.28969

    Article  CAS  PubMed  Google Scholar 

  10. Hemminki K, Försti A, Sundquist K, Li X (2016) Cancer of unknown primary is associated with diabetes. Eur J Cancer Prev 25:246–251. https://doi.org/10.1097/CEJ.0000000000000165

    Article  CAS  PubMed  Google Scholar 

  11. Jungehülsing M, Eckel HE, Staar S, Ebeling O (2000) Diagnostik und Therapie des okkulten Primärtumors mit Lymphknotenmetastasen im Kopf‑, Halsbereich. In: König B, Reinhardt D, Schuster H‑P (Hrsg) Kompendium der praktischen Medizin. Springer, Berlin, Heidelberg, S 849–861

    Chapter  Google Scholar 

  12. Kazmierczak PM, Nikolaou K, Rominger A et al (2014) Radiologische Diagnostik des CUP-Syndroms. Radiologe 54:117–123. https://doi.org/10.1007/s00117-013-2547-9

    Article  CAS  PubMed  Google Scholar 

  13. Koivunen P, Laranne J, Virtaniemi J et al (2002) Cervical metastasis of unknown origin: a series of 72 patients. Acta Otolaryngol 122:569–574. https://doi.org/10.1080/00016480260092435

    Article  PubMed  Google Scholar 

  14. Kraywinkel K, Zeissig SR (2017) Epidemiologie des CUP-Syndroms in Deutschland. Onkologe 23:966–973. https://doi.org/10.1007/s00761-017-0301-z

    Article  Google Scholar 

  15. Krombach GA (2015) Hals. In: Kösling S, Bootz F (Hrsg) Bildgebung HNO-Heilkunde. Springer, Berlin, Heidelberg, S 463–530

    Chapter  Google Scholar 

  16. Krombach GA, Mahnken AH (2015) Radiologische Diagnostik Abdomen und Thorax: Bildinterpretation unter Berücksichtigung anatomischer Landmarken und klinischer Symptome https://doi.org/10.1055/b-003-109648

    Book  Google Scholar 

  17. Kwee TC, Kwee RM (2009) Combined FDG-PET/CT for the detection of unknown primary tumors: systematic review and meta-analysis. Eur Radiol 19:731–744. https://doi.org/10.1007/s00330-008-1194-4

    Article  PubMed  Google Scholar 

  18. Lan M, Huang Y, Chen C‑Y et al (2015) Prognostic value of cervical nodal necrosis in nasopharyngeal carcinoma: analysis of 1800 patients with positive cervical nodal metastasis at MR imaging. Radiology 276:536–544. https://doi.org/10.1148/radiol.15141251

    Article  Google Scholar 

  19. Le Chevalier T, Cvitkovic E, Caille P et al (1988) Early metastatic cancer of unknown primary origin at presentation. A clinical study of 302 consecutive autopsied patients. Arch Intern Med 148:2035–2039

    Article  CAS  Google Scholar 

  20. Lee G, Hall RR (2016) Cancer stem cells: cellular plasticity, niche, and its clinical relevance. J Stem Cell Res Ther. https://doi.org/10.4172/2157-7633.1000363

    Article  PubMed  Google Scholar 

  21. Ligey A, Gentil J, Créhange G et al (2009) Impact of target volumes and radiation technique on loco-regional control and survival for patients with unilateral cervical lymph node metastases from an unknown primary. Radiother Oncol 93:483–487. https://doi.org/10.1016/j.radonc.2009.08.027

    Article  CAS  PubMed  Google Scholar 

  22. Mackenzie K, Watson M, Jankowska P et al (2016) Investigation and management of the unknown primary with metastatic neck disease: United Kingdom national multidisciplinary guidelines. J Laryngol Otol 130:S170–S175. https://doi.org/10.1017/S0022215116000591

    Article  CAS  PubMed  Google Scholar 

  23. Mozet C, Wichmann G, Stumpp P et al (2013) Zervikales CUP-Syndrom. Onkologe 19:44–51. https://doi.org/10.1007/s00761-012-2315-x

    Article  Google Scholar 

  24. Pavlidis N (2007) Forty years experience of treating cancer of unknown primary. Acta Oncol 46:592–601. https://doi.org/10.1080/02841860701243095

    Article  PubMed  Google Scholar 

  25. Pavlidis N, Briasoulis E, Hainsworth J, Greco FA (2003) Diagnostic and therapeutic management of cancer of an unknown primary. Eur J Cancer 39:1990–2005. https://doi.org/10.1016/S0959-8049(03)00547-1

    Article  CAS  PubMed  Google Scholar 

  26. Pentheroudakis G, Golfinopoulos V, Pavlidis N (2007) Switching benchmarks in cancer of unknown primary: from autopsy to microarray. Eur J Cancer 43:2026–2036. https://doi.org/10.1016/j.ejca.2007.06.023

    Article  PubMed  Google Scholar 

  27. Sekine T, de Galiza Barbosa FG, Sah B‑R et al (2017) PET/MR outperforms PET/CT in suspected occult tumors. Clin Nucl Med 42:e88–e95. https://doi.org/10.1097/RLU.0000000000001461

    Article  PubMed  Google Scholar 

  28. Varadhachary GR, Raber MN, Matamoros A, Abbruzzese JL (2008) Carcinoma of unknown primary with a colon-cancer profile—changing paradigm and emerging definitions. Lancet Oncol 9:596–599. https://doi.org/10.1016/S1470-2045(08)70151-7

    Article  PubMed  Google Scholar 

  29. Zaun G, Schuler M, Herrmann K, Tannapfel A (2018) CUP Syndrome. Dtsch Arztebl Int. https://doi.org/10.3238/arztebl.2018.0157

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66421, Homburg/Saar, Deutschland

    Frederik Fries

Authors
  1. Frederik Fries
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Frederik Fries.

Ethics declarations

Interessenkonflikt

F. Fries gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fries, F. CUP-Syndrom im Halsbereich. Radiologe 60, 1047–1051 (2020). https://doi.org/10.1007/s00117-020-00752-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00117-020-00752-9

Schlüsselwörter

Keywords

Search

Navigation