Cancer Of Unknown Primary

Cancer of unknown primary (CUP) means that cancer spread has been found somewhere in your body (secondary cancer), but your doctors can’t find where the cancer started (the primary cancer). Approximately 3-5% of cancer diagnoses are CUP.

It is thought that there are several reasons why it is difficult to find the primary cancer (the original source of the tumour):

• The primary cancer is too small to be seen by scans or camera tests or hidden behind a larger secondary cancer.
• Although it has already spread it may now have disappeared. This usually happens if the cancer has had its blood supply cut off.
• Your immune system may have destroyed the primary cancer but not before it had already spread to secondary site(s).

Investigations

When a new tumour is found it is not always obvious what type of cancer it is so further tests and investigations need to be done to try and find out. In CUP, this process can take longer as more tests may be needed to try and find out where the cancer came from.

What Tests Will Be Done?

This will vary for every person but may include the following:

• Blood Tests: to detect substances in your blood called tumour markers which are made by some cancers.
• Chest X-ray: and sometimes x-rays of other areas of your body.
• Imaging Scans – Ultrasound, CT, MRI, PET or Bone Scans: One or more of these may be requested by the doctor. Some tests are performed at Northern General Hospital, Sheffield.
• Urine and stool specimens: These may be collected as they can show abnormal cells (in urine) and hidden blood (in stools).
• Biopsy: Where a sample of the abnormal tissue is taken and sent for analysis.

Sometimes the primary tumour cannot be found. If this is the case a management plan will be made with the results already obtained and this will depend on your health and wellbeing.

You may decide that if treatment is offered that you do not want it, in which case further tests would not be beneficial. You will be referred to district nurses on discharge from hospital /following outpatient appointment for support and you may be referred to Community Macmillan Team as appropriate.

If you choose to have treatment you will be referred to an oncologist for an appointment.

Is your care planned?

The CUP Multi-Disciplinary Team (MDT) meets every week on a Tuesday at Doncaster Royal Infirmary to discuss all newly diagnosed patients. The MDT consists of a Consultant in Specialist Palliative Medicine, Consultant Oncologist, Associate Gastro-enterologist, CUP Specialist Nurse, Radiologist and Histopathologist. The investigations that have been performed as well as all relevant information are discussed and a recommended treatment plan agreed.

This will then be discussed with you in the outpatient department or on the ward if you are an inpatient and a management plan made. We welcome and encourage all patients to bring along a family member or a friend for additional support to any consultation.

What is the treatment for CUP?

The most common treatment for CUP is Chemotherapy where anticancer drugs are given through a drip or as oral medication. This is a systemic treatment which means it treats cancer in more than one area of the body. Radiotherapy (X-ray treatment) may also be offered dependent on your symptoms and where the secondary cancer is located.

Both these treatments are palliative in nature which means that we cannot cure it but we aim to shrink it and/or slow the growth of disease hopefully improving your symptoms and quality of life. You may be asked to participate in research trials at any point of your treatment if appropriate.

Supportive and/or palliative care with medicines to control your symptoms can be an important part of treatment for people with CUP. Patients and their families who require ongoing symptom management and support will be seen by the specialist palliative care team either within the hospital or community.

This may be because the cancer is very advanced when diagnosed and the disadvantages of treatment outweigh the advantages.

Keyworker

If you are diagnosed with CUP you will be referred to Cancer of Unknown Primary Service and you will be allocated a key worker to help support you. This will usually be a specialist nurse. Your key worker will help co-ordinate your care and help answer all your questions and concerns and support you through this difficult time.

Acute Oncology/Cancer of Unknown Primary Nurse Specialist
Doncaster & Bassetlaw Hospitals NHS Foundation Trust

Contact Number:
Monday to Friday 9.00am – 5.00pm
Doncaster Royal Infirmary, Tel: 01302 642882
Bassetlaw Hospital, Tel: 01909 500990 ext 2981

Where can I find out more?

Macmillan Living Well Cancer Information & Support Service
St John’s Information & Support Centre
Weston Road
Balby
Doncaster
DN4 8JS
Helpdesk, Tel: 01302 796853.

Aurora Wellbeing Centre and Macmillan Hub
The Old Library
Memorial Avenue
Worksop
S80 2BP
Open 9.30am-4.30pm Mon-Fri
Tel 01909 470985
Email: macmillan@aurorawellbeing.org

Designed by Medical Photography & Graphic Design, DBHFT. 01302 366666 ext. 3736

Patient Experience Team

The team are available to help with any concerns/complaints you may have about your experience at the Trust. Their office is in the Main Foyer (Gate 4) of Doncaster Royal Infirmary. Contact can be made either in person, by telephone or email.

The contact details are:
Telephone: 01302 553140 or 0800 028 8059.
Email: pals.dbh@dbh.nhs.uk

Aurora Wellbeing Centres also situated at:
Bassetlaw Hospital
Doncaster Royal Infirmary
Montagu Hospital
18 Scot Lane
Kilton Hill
Armthorpe Road
Adwick Road
Doncaster
Worksop
Doncaster
Mexborough
DN1 1LD
S61 0BD
DN2 5LT
S64 0AZ
Freephone: 0300 0111202

The information and support centre provides a wide variety of services including information, counselling, practical support and therapy options. They can also signpost patients, carers and loved ones to other services in the area such as support groups.

Support Groups

Doncaster Cancer Support Group
1st Wednesday of every month
6.30pm – 8.00pm
Boardroom (Gate 4)
Doncaster Royal Infirmary
Armthorpe Road
DN2 5LT
For more information please contact, Tel: 01302 381331 / 553115.

Useful websites:

www.cupfoundjo.org
www.macmillan.org.uk