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Menino’s cancer of unknown origin raises many questions

Menino’s cancer of unknown origin raises many questions

Former mayor Thomas Menino’s recently announced mystery cancer diagnosis has many of us scratching our heads. How is it possible for a stealth cancer to spread to a person’s liver and lymph nodes without leaving a trace of where it originated?

Last year, about 31,000 cancer patients in the United States received a similar diagnosis — called cancer of unknown primary — according to the American Cancer Society. That number represents fewer than 2 percent of all patients diagnosed with cancers.

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“These cases are perplexing,” said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society. They have a poor prognosis and are harder to treat because oncologists can’t pick from a list of chemotherapy drugs approved for a particular cancer.

Broad-spectrum drugs that treat an array of cancers are typically chosen, but doctors don’t have the “level of certainty” they’d like when beginning treatment, Lichtenfeld said.

Menino began chemotherapy for the cancer detected in his liver and lymph nodes earlier this month at Dana-Farber Cancer Institute. His physicians there declined to comment on his treatment.

In trying to locate the original tumor, his doctors likely employed imaging scans, ran blood tests to screen for tumor markers or genetic mutations, and examined the malignant cells under a microscope to look for distinguishing features, speculated Dr. Gauri Varadhachary, medical director of the gastrointestinal cancer center at MD Anderson Cancer Center in Dallas, who has not reviewed Menino’s medical records. “There isn’t one specific test we can do to determine the kind of cancer.” D.K.

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.
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