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Cancer of unknown primary

Cancer of unknown primary (CUP) means that cancer spread has been found in your body (secondary cancer), but your doctors can't find where the cancer started (the primary cancer). It is sometimes called unknown primary cancer or unknown primary tumour.

What is a primary cancer?

The primary cancer is the place where a cancer starts growing. Cells from this primary site may break away and spread to other parts of the body through the bloodstream or lymphatic system. These escaped cells can then grow and form other tumours, which are known as secondary cancers or metastases.

Treatments for cancer of unknown primary at CUH

The treatment for cancer of unknown primary depends on several factors, such as tumour type, location and body part affected. The main treatment for CUP is cancer drugs, most commonly chemotherapy. You often have a combination of 2 or 3 chemotherapy drugs. You may also have radiotherapy to help control your symptoms or hormone therapy to slow or stop the cancer's growth.

Why the CUP team and what happens?

You may come under the care of the CUP team for many reasons and from various sources. You will have been referred to us by another service. This could be your GP, the Emergency Department, a hospital consultant, or another oncology consultant who has identified that you may have a form of cancer and would like us to investigate on your behalf.

Our main aims are to:

  • Ensure your case is promptly discussed by the multi-disciplinary team.
  • Investigate your symptoms with the aim of diagnosis as quickly as possible.
  • Liaise with the appropriate team or co-ordinate your care after diagnosis.
  • Offer treatment options, care or support to match your needs.
  • Keep you informed throughout.
  • Follow up your care on completion of treatment.

Multi-disciplinary team (MDT)

All cases are discussed at an MDT meeting. The MDT consists of doctors, nurses and other disciplines working together to ensure you receive coordinated care throughout your journey from initial investigation to treatment. At these meetings the team will look at any scans, investigations, biopsy results and your history to help guide all aspects of your care.

What happens at clinic?

The CUP clinic occurs on a Wednesday afternoon in clinic 12, level 3 of the outpatient department. At this clinic you may be seen by a consultant, specialist registrar, specialist nurse, dietician or radiographer depending on your care needs. The clinic is for new patients currently having investigations prior to diagnosis, newly diagnosed patients and those being followed up.

Following investigations a formal diagnosis may be given to you. In some cases the results of your tests will show where the cancer has started, and this will be discussed with you in the clinic. In these cases you will be referred to the most appropriate team to continue your care and treatment. In 2% of patients it will not be possible to identify a primary cancer and you will receive a diagnosis of cancer of unknown primary (CUP). At this point you will be able to discuss with the team treatment options. In a small portion of patients referred to the team the final diagnosis will not be cancer and in these cases, you will be referred to a relevant team or to your GP.

Our aim is to provide you with information about your condition and access to the best treatment for it. This may involve surgery, chemotherapy or radiotherapy, as well as other supportive measures that may be of benefit. You also may not wish to have further investigations or treatment. We are here to help you in the decision-making process. Our hospital is a major cancer research centre involved in developing new treatments to improve outcomes, so you may be offered the opportunity to take part in a research study which may benefit you and/or future generations.

We encourage you to bring someone with you to clinic as you may feel anxious or find that there is lots of information to take on board. Please write down any questions you may have and bring them with you.

Who do I contact?

On visiting the clinic you will be given the name of the most appropriate person to contact if you have any queries. These details may change if we refer you to a different team following diagnosis.

  • Helen Whatling - CUP specialist nurse 01223 257071
  • Oncology reception 01223 216551
  • Oncology Day unit 01223 217099
  • Radiotherapy Reception 01223 216634
  • Oncology 24-hour emergency line 01223 274224

Follow up after completion of treatment

After your treatment has finished, you may continue to have regular check-ups in clinic. If you travel a long way this may be more appropriate at a hospital closer to your home and this can be arranged. At follow up appointments you will be asked about your general health and well-being and whether you have symptoms that you are concerned about. If you are worried or notice any new symptoms between appointments, you must let us know as soon as possible. You don’t have to wait until your next appointment. Please use the contact details listed above.

When should I see my GP?

Your GP is in charge of your overall care. At each hospital clinic appointment or admission a letter is written and sent to your GP so that they are fully informed of your progress and a copy of this letter will be provided for you unless you do not wish to receive one (please tell your doctor or nurse if this is the case).

Please seek advice from your GP for all aspects of your care other than those directly related to your cancer. If the GP is concerned about your symptoms they can contact us for further advice.

Please remember, if you have any worries/concerns about your cancer we recommend that you phone us first.

Privacy and dignity

Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high-tech equipment and/or specialist one to one care is required.

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