Metastatski tumori nepoznatog porekla - dijagnostičko terapijske dileme

Patients with metastases in various organs and/or lymph nodes, without definite primary site, represent a heterogeneous group with many difficulties in diagnosis and treatment. This relatively rare syndrome is very challenging and often frustrates the clinician, which may result in extensive and expensive diagnostic procedures. The reported incidence of these tumors is 2-12% with male preponderance. Median age is about 60 yrs, with adenocarcinoma as most frequent histological subtype. Prognosis is generally poor with median survival of 4-8 months, with small proportion of long-term survivors (5-10%). Optimal therapy for patients with this syndrome has not yet been delineated. About 30% of patients belong to treatable subsets, while 70% of patients do not fall into these categories and no regimen has been firmly established as standard therapy for them. Having this in mind, it is recommended to include appropriate patients in randomized clinical studies, while for the others the best supportive care is mandatory.