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Integrating the time factor into the definition of metastasis of unknown origin.

Patients with cancer of unknown primary site are common, representing 5%10% of all cancer patients (7). Combination chemotherapy, often used with surgery or radiation therapy, has proved to be potentially curative for several metastatic tumors of known primary site. Likewise, some patients with metastasis of unknown origin (MUO) also have responsive neoplasms and could be treated successfully (2,3). There is no doubt that, unless the primary tumor is promptly diagnosed and treated, most of these cases will have a rapid downhill course. Therefore, time is also an important factor in the workup and management of these patients.