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Cancer of Unknown Primary
Cancer of unknown primary (CUP) is the term used to describe a metastatic cancer (cancer that has spread) with an unknown starting point.
CUP is the eighth most common cancer in men and the ninth most common in women1. It is the sixth most common cause of cancer death in Australians, causing around 5% of cancer deaths.
Usually, when cancer spreads the secondary cancer cells look like abnormal versions of the primary cancer cells (in the tissue where the cancer began). For example, if breast cancer spreads to the lungs, the metastatic tumour in the lung is made up of cancerous breast cells (not lung cells) and is then described as metastatic breast cancer (not lung cancer).
If it is not possible to identify the type of cancer cells the diagnosis is CUP.
Incidence and mortality
In 2009, close to 2,900 people in Australia were diagnosed CUP.
In 2007, there were 2344 deaths in Australia due to CUP.
There is no screening method for CUP.
Symptoms and diagnosis
Some people with metastatic cancer have no symptoms, but common symptoms include:
- breathlessness or discomfort in the chest
- bone pain, back pain
- swelling and discomfort in the abdomen, fluid collecting in the abdomen (ascites), yellowing of the skin and eyes (jaundice)
- swollen lymph glands such as those in the neck, underarm, chest or groin
- general symptoms such as weight loss, headaches, no appetite, feeling extremely tired.
Tests are ordered to ensure that cancers which are still curable or treatable, even when spread, are not missed. Tests may include a biopsy, physical examination, x-ray and blood test. Further diagnostic tests are done, based on the site of the secondary cancer/s and any ‘clues’ as to where the cancer may have started.
Diagnostic tools include blood biochemistry (checking for markers for cancers such as breast or prostate that could be treated with hormones), faecal occult blood testing, urinalysis, histopathogical review of all biopsy material using immunohistochemistry, CT of the abdomen and pelvis, mammography and PET scan.
Staging systems differ for different cancer types. For most cancers there are four stages, with stage 1 being an early cancer and stage 4 an advanced cancer. Because a CUP has already spread, it must be stage 2 or higher. If it has spread to another body organ, it is a stage 4 cancer.
For patients with CUP the primary cancer site is not known, therefore it is difficult to identify risk factors. Smoking may be an important risk factor, as more than half of CUP patients have a history of smoking. Other risk factors may include older age, diet, alcohol and obesity – common risk factors for many cancers.
Since the causes of CUP are unknown, there is no prevention advice specific to this disease. Having a generally healthy lifestyle – including not smoking, maintaining a healthy diet and weight and limiting alcohol consumption – may be protective.
For most cancers, treatment is determined by the type of cancer and depends on correct diagnosis and staging. Because the primary cancer is unknown, there is no standard treatment for CUP.
The main treatment used for CUP is broad spectrum chemotherapy unless the unknown primary is in a very specific area. For example, neck nodes are usually treated like head and neck cancer, axillary node presentations are treated in the same manner as breast cancers, and peritoneal presentations are treated like ovarian cancer.
For most individuals diagnosed with cancer prognosis depends on the type and stage of cancer, as well as their age and general health at the time of diagnosis. CUP is not diagnosed until a patient has metastatic cancer, and treatment is difficult because the primary cancer type can not be determined. Five year survival for people in Australia diagnosed with CUP is 16%.
For more information, contact Cancer Council Helpline on 13 11 20 (cost of a local call).1) Excluding non-melanoma skin cancer, which is the most commonly diagnosed cancer according to general practice and hospitals data, however there is no reporting of cases to cancer registries.
For more information
- Australian Institute of Health and Welfare 2012. Cancer survival and prevalence in Australia: period estimates from 1982 to 2010. Cancer Series no. 69. Cat. no. CAN 65. Canberra: AIHW.
- Australian Institute of Health and Welfare (AIHW) 2011. ACIM (Australian Cancer Incidence and Mortality) Books. AIHW: Canberra
- Australian Institute of Health and Welfare & Australasian Association of Cancer Registries 2012. Cancer in Australia: an overview, 2012. Cancer series no. 74. Cat. no. CAN 70. Canberra: AIHW.
- Australian Institute of Health and Welfare (AIHW) 2012. Cancer data: Pivot table. AIHW: Canberra. Available from http://www.aihw.gov.au/cancer-data/.
This page was last updated on: Tuesday, January 8, 2013