Gastrointestinal cancer educational case series: management of metastatic adenocarcinoma of unknown primary origin in a Ph+ ALL survivor.

INTRODUCTION: Secondary malignancies and chronic end-organ sequelae are significant and steadily rising consequences of cancer therapy. The workup and management of a carcinoma of unknown primary must consider the patient's clinical presentation, radiologic and pathologic findings, and comorbidities. CASE REPORT: We present the case of a 50-year-old female survivor of Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) with significant treatment-related end-organ sequelae who developed a metastatic adenocarcinoma of unknown primary 15 years following curative therapy for her ALL. The complex management issues related to the investigations and choice of therapy for this patient are reviewed. DISCUSSION: This case discusses key issues related to the workup and management of a carcinoma of unknown primary. In addition, it illustrates the importance of taking patient comorbidities into consideration and tailoring investigations and therapy accordingly.