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Diagnosis and Management of Metastatic Malignant Disease of Unknown Primary Origin

The term “cancer of unknown primary” refers to a condition in which a patient has metastatic malignancy without an identified primary source. This is a very heterogeneous disease in which the type of tumour, the extent of spread, and the outcome of treatment all vary widely. When categorising patients with cancer of unknown primary, one important factor initially considered is the cell type of origin of the metastatic disease. The majority of patients have malignancy which appears to derive from epithelial cells, and hence are regarded as having carcinoma of unknown primary. Patients with tumours of non-epithelial lineage (melanoma, sarcoma, lymphoma, germ-cell) form a distinct and important minority, since subsequent management can often be satisfactorily undertaken even in the absence of an identifiable primary source. Such patients are not considered in this guideline, since their care is adequately defined in existing guidelines for their specific tumour type. The term “carcinoma of unknown primary” (CUP) is used henceforth to refer to those patients with metastatic malignancy of epithelial, neuroendocrine or undifferentiated lineage whose investigation and management is considered within the scope of this guideline.

NICE Clinical Guidelines - National Collaborating Centre for Cancer (UK).

Version: July 2010

Management of Renal Masses and Localized Renal Cancer [Internet]

To summarize the evidence on the effectiveness and comparative effectiveness of strategies for evaluating and treating patients with a renal mass suspicious for renal cell carcinoma, including use of composite models for predicting malignancy at initial diagnosis, use of percutaneous renal sampling (by fine needle aspiration or core biopsy) to establish a diagnosis, and comparative efficacy of radical nephrectomy, partial nephrectomy, thermal ablation, and active surveillance.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: February 2016
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Myeloma: Diagnosis and Management

The management of myeloma is complex and challenging. It increasingly involves the use of expensive drugs. The guideline will aim to raise standards nationally while allowing clinical flexibility and defining a common pathway for patients at various stages of their illness, and of different ages and levels of fitness. Although a consistent approach to management is desirable, it needs to reflect the very different groups of patients with myeloma from the fit and suitable for transplant, fairly fit but not suitable for transplant to patients who are extremely frail and/or unwell.

NICE Guideline - National Collaborating Centre for Cancer (UK).

Version: February 2016
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Technology Assessment on Genetic Testing or Molecular Pathology Testing of Cancers with Unknown Primary Site to Determine Origin [Internet]

This technology assessment reports the results of our review of the existing literature on commercially available genetic tests that are used to identify the tissue of origin (TOO) of the cancer in patients with cancer of unknown primary (CUP) site. CUP is a case of metastatic tumor for which the primary TOO remains unidentified after comprehensive clinical and pathologic evaluation. This review focused on analytical and clinical validity of the tests and their utility in guiding the diagnosis and treatment of CUP and improving health outcomes.

Technology Assessment Report - Agency for Healthcare Research and Quality (US).

Version: February 20, 2013
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Suspected Cancer: Recognition and Referral

Cancer is an important condition, both in terms of the number of people affected and the impacts on those people and the people close to them. Around one third of a million new cancers are diagnosed annually in the UK, across over 200 different cancer types. Each of these cancer types has different presenting features, though there may be overlap. More than one third of the population will develop a cancer in their lifetime. Although there have been large advances in treatment and survival, with a half of cancer sufferers now living at least ten years after diagnosis, it remains the case that more than a quarter of all people alive now will die of cancer.

NICE Guideline - National Collaborating Centre for Cancer (UK).

Version: June 2015
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Metastatic Spinal Cord Compression: Diagnosis and Management of Patients at Risk of or with Metastatic Spinal Cord Compression

It is difficult to know what the true incidence of metastatic spinal cord compression (MSCC) is in England and Wales because the cases are not systematically recorded. However, evidence from an audit carried out in Scotland between 1997 and 1999 and from a published study from Ontario, Canada, suggests that the incidence may be up to 80 cases per million population per year. This would mean around 4000 cases per year in England and Wales or more than 100 cases per cancer network per year.

NICE Clinical Guidelines - National Collaborating Centre for Cancer (UK).

Version: November 2008

Urinary Incontinence in Neurological Disease: Management of Lower Urinary Tract Dysfunction in Neurological Disease

The guideline covers adults and children (from birth) with lower urinary tract dysfunction resulting from neurological disease or injury.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: August 2012

Drug Class Review: Newer Diabetes Medications, TZDs, and Combinations: Final Original Report [Internet]

To compare the effectiveness and adverse event profiles of amylin agonists, DPP-4 inhibitors, incretin mimetics, TZDs, and certain combination products for people with type 2 diabetes and for people with type 1 diabetes for pramlintide only.

Drug Class Reviews - Oregon Health & Science University.

Version: February 2011
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Advanced Breast Cancer: Diagnosis and Treatment

Breast cancer is the most common cancer for women in England and Wales, with about 37,000 new cases diagnosed and 11,000 deaths recorded in England and Wales each year. In men breast cancer is rare, with about 270 cases diagnosed, and 70 deaths in England and Wales each year. Of these new cases in women and men, around 10% are diagnosed in the advanced stages, when the tumour has spread significantly within the breast or to other organs of the body. In addition, there is a significant number of women who have been previously treated with curative intent who subsequently develop either a local recurrence or metastases. Over recent years there have been important developments in the investigation and management of these patients including new chemotherapy, and biological and hormonal agents. There is some evidence of practice variation across the country and of patchy availability of certain treatments and procedures. A clinical guideline will help to address these issues and offer guidance on best practice.

NICE Clinical Guidelines - National Collaborating Centre for Cancer (UK).

Version: February 2009
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Unusual Cancers of Childhood Treatment (PDQ®): Health Professional Version

Expert-reviewed information summary about the treatment of unusual cancers of childhood such as cancers of the head and neck, chest, abdomen, reproductive system, skin, and others.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: November 30, 2016

Wilms Tumor and Other Childhood Kidney Tumors Treatment (PDQ®): Health Professional Version

Expert-reviewed information summary about the treatment of Wilms tumor.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: November 30, 2016

Unusual Cancers of Childhood Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of unusual cancers of childhood such as cancers of the head and neck, chest, abdomen, reproductive system, skin, and others.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: December 1, 2016

Gastrointestinal Complications (PDQ®): Health Professional Version

Expert-reviewed information summary about constipation, impaction, bowel obstruction, and diarrhea as complications of cancer or its treatment. The management of these problems is discussed.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: September 9, 2016

Genetics of Endocrine and Neuroendocrine Neoplasias (PDQ®): Health Professional Version

Expert-reviewed information summary about the genetics of endocrine and neuroendocrine neoplasias. This summary contains information about the MEN1 gene, the RET gene, genetic testing, and clinical interventions. Psychosocial issues associated with genetic testing and counseling of individuals who may have a hereditary medullary thyroid cancer syndrome are also discussed.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: November 18, 2016

Wilms Tumor and Other Childhood Kidney Tumors Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of Wilms tumor.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: December 1, 2016

Childhood Cancer Genomics (PDQ®): Health Professional Version

Expert-reviewed information summary about the genomics of childhood cancer. The summary describes the molecular subtypes for specific pediatric cancers and their associated clinical characteristics, the recurring genomic alterations that characterize each subtype at diagnosis or relapse, and the therapeutic and prognostic significance of the genomic alterations. The genomic alterations associated with brain tumors, kidney tumors, leukemias, lymphomas, sarcomas, and other cancers are discussed.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: October 14, 2016

Late Effects of Treatment for Childhood Cancer (PDQ®): Health Professional Version

Expert-reviewed information summary about the health problems that continue or appear after cancer treatment has ended.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: October 21, 2016

Diabetes Medications for Adults With Type 2 Diabetes: An Update [Internet]

To evaluate the comparative effectiveness and safety of monotherapy and metformin-based combination therapy for type 2 diabetes.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: April 2016

Genetics of Breast and Gynecologic Cancers (PDQ®): Health Professional Version

Expert-reviewed information summary about the genetics of breast and gynecologic cancers, including information about specific genes and family cancer syndromes. The summary also contains information about interventions that may influence the risk of developing breast and gynecologic cancers in individuals who may be genetically susceptible to these diseases. Psychosocial issues associated with genetic testing are also discussed.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: December 1, 2016

Breast Cancer Screening (PDQ®): Health Professional Version

Expert-reviewed information summary about tests used to detect or screen for breast cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: December 1, 2016

Systematic Reviews in PubMed

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