What is "undifferentiated carcinoma"?

May 8, 2006 11:17 AM

What is "undifferentiated carcinoma"? Data on survivability?

I got an e-mail from my father just now, excerpted below. We are not very close (I haven't seen him in five years), so I am reluctant to follow up with a bunch of questions. Still, as one might imagine, this is fucking my shit up this afternoon.

I haven't been able to come up with anything worthwhile from Google. What is "undifferentiated carcinoma"? Is there any data on survivability? What is the treatment?


The e-mail:
"I got some not so good news frm the doc that I have some kind of undifferentiated carcinoma.... Anyway, it's cancer. The VA has been screwing around for over 3 months to get a swollen lymph node diagnosed and a cpl weeks ago they finally did a needle biopsy, then last monday they took the lymph node in my neck, under the jaw, out surgically. .... It seems the cancer is coming from somewhere else so they are doing ct scan, ultra sound etc etc etc, ad infinitem. Worst part of the whole deal so far has been wondering what the hell it is while I waited weeks between appointments, thought it might be lymphoma but I guess it's not. I feel just fine except for a little stress, kind of anxious to find out what the future holds..."

posted by juliewhite to health & fitness (11 answers total)

Undifferentiated means pretty much what it sounds like; the cells are very primitive and do not obviously come from the lungs, the colon, or wherever. When undifferentiated cells are found via a lymph node biopsy it is assumed they are metastatic so a workup like the one your father described is done to find the primary source. The prognosis of someone in this state depends on what they find during the metastatic workup; i.e. where the primary cancer is, how widely and where it has spread, what drugs/treatments it is likely to be sensititve to. Obviously a situation as described is potentially serious, but there is not enough information here for a more specific answer. I wish your father and the rest of the family luck.
posted by TedW at 11:24 AM on May 8, 2006

I'm very sorry, good luck to you and your father.

From here (couldn't tell you the reliability of the source):

Carcinoma is a malignant tumour (cancer) of glandular cells (cells in the lining surfaces of the body). A carcinoma is said to be "undifferentiated" when the tumour cells have no resemblance at all to normal glandular or surface lining cells. Such "undifferentiated" cancers are generally more aggressive than "differentiated" ones. The response to treatment and long term effects are however dependent on the treatment given and sometimes on the exact site of the cancer. In case of breast carcinoma, the treatment given generally is wide removal of the tumour or the whole breast (depending on the size of tumour) and a follow-up by chemotherapy or radiotherapy. Some of these tumours are known to respond well to proper treatment given well in time.
posted by schroedinger at 11:24 AM on May 8, 2006

Wikipedia states that carcinoma tumors are classified by appearance, but some do not have a classifiable appearance and are thus "undifferentiated".

Treatment and prognosis depends on where the cells originated and the degree of differentiation from the parent tissue.

So sorry, and best of luck to all involved.
posted by ewagoner at 11:29 AM on May 8, 2006

Cells differentiate into different tissues and organs. If a cell is undifferentiated, it means the pathologist could not decide what organ the cell came from.

Treatment depends on what additional information, if any, your father's oncologist has about the diagnosis. A second opinion, possibly a second biopsy of a different site, might clarify the diagnosis. Pathologists look at the biopsy under the microscope to decide what type of cancer it is; sometimes different pathologists disagree as to what to call the diagnosis.

Where was the biopsy done? If in a smaller hospital, perhaps a second opinion can be obtained at a major university hospital.

As others have said, additional tests are required to find the initial source of the cancer.
posted by cahlers at 11:29 AM on May 8, 2006

I'm a pathologist (so I diagnose cancer everyday). TedW is certainly on the right track.

First, a little terminology:
*grading: this is the process by which a pathologist assigns a neoplasm to a particular grade. Based on overall appearance of the cells, formation of secondary structures, presence of necrosis, and mitotic activity (rate of cellular growth). Of course, like most other things in surgical pathology, performed by microscopy.

*differentiated: generally would describe cells of an identifiable origin. That is, cells which maintain the appearance, function, and architecture of normal (or non-malignant tissue). A differentiated adenocarcinoma, for example, would have the appearance of glandular-type epithelial cells that are forming secondary glandular structures (eg. ducts, tubules, or crypts). Classified as either well-differentiated or poorly differentiated, based upon the relative change to malignant features from normal cells.

*undifferentiated: very general type term. Bascially, when a pathologist describes a neoplasm as undifferentiated they are unable to tell prescisely what type of progenitor cell the cancer arose in. As malignant change occurs in cells, they devolve from the appearance and function of the type of cell that they arose from, and tend to resemble a more primitive precursor cell. The more primitive (further away from well-differentiated) a neoplasm is the more aggressive and higher chance of metastatic spread.

In your father's case, the way that his case would be handled is like this. Carcinoma does not arise on its own in a lymph node. Therefore, this is a metastases from an unknown primary cancer. There are techniques (immunohistochemistry) to determine where this came from. They are generally very good, but sometimes, even after following them, you can only narrow down a list of potential diagnoses by eliminating sources. An exhaustive search should be made for the primary. CT scans, MRI, and PET scans are the usual route for this. Also probably something else in your father's case (see below).

Since his cancer is metastatic to his submandibular lymph node (under the jaw), there is a high likelihood that he has a squamous cell carcinoma of the head and neck. Statistically, that's where I would place my bet. In that case, since he doesn't have a primary, they will probably perform random biopsies of the mucosa of his throat (oropharynx), and tongue. This is called 'Waldeyer's Ring sampling.' Of course, this is highly associated with long-term tobacco smoking and alcohol intake (all head and neck cancer is).

As far as treatment goes, I can't comment at length since I don't deal with that aspect of patient care. However, most head and neck carcinomas are treated with surgery to remove the primary, with chemo/radiation post-operatively.

This is actually a classic teaching example in pathology. For metastatic squamous cell carcinomas of unknown primary to a neck lymph node, the classic location for the primary is in the crypts of the tonsils.

Good luck with your father.
posted by i_am_a_Jedi at 12:07 PM on May 8, 2006 [3 favorites]

if it reached as far down as the supraclavicular nodes, on the left side especially, doesn't that mean it could really have metastasized from almost anywhere?
posted by kcm at 1:22 PM on May 8, 2006

Purely anecdotal information: this sounds like something my father had in 2000. Same lymph node, then surgery to remove that plus some other surrounding tissue. The ENT thought the cancer had probably originated somewhere near his jaw, but the CT couldn't show the area very well as it got interference from his fillings. About a month after the surgery, they started radiation on his jaw and throat and continued that for maybe 5 or 6 months (I'm no longer sure). It was pretty nasty, and burned the crap out of him, but he is still alive and still (mutter, mutter, cuss) smoking.
posted by dilettante at 2:00 PM on May 8, 2006

What a great Board and wealth of information--I am gobsmacked--I wish you all the best.
posted by rmhsinc at 3:02 PM on May 8, 2006

@kcm

Of course, in theory a metastatic lesion in a lymph node could represent spread from a primary of almost any area. However, location and drainage make certain cancers more likely than others.

Interestingly enough, an isolated supraclavicular lymph node can represent an abdominal malignancy and has the eponym Virchow's node or Troisier's Node.
posted by i_am_a_Jedi at 4:16 PM on May 8, 2006

There's not much to add to Jedi's fantastic posts. Occasionally, however, after a careful search, the site of origin of the carcinoma cannot be found. If the pathologist also finds that his microscopy and immunofluorescence is unrevealing, then what you have is a metastatic carcinoma of unknown primary.

As of 1994, when my outdated edition of Harrison's internal medicine was published, the standard of care for unknown primary metastatic carcinoma was cis-platinum based chemotherapy, and the 5 year survival was about 30%.
posted by ikkyu2 at 7:03 PM on May 8, 2006

Thanks for the information everyone!
posted by juliewhite at 12:16 PM on May 9, 2006