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What is Cancer of Unknown Primary?
Cancer of unknown primary (CUP) means that cancer spread has been found in your body (secondary cancer), but your clinicians can't find where the cancer started (the primary cancer). It is sometimes called unknown primary cancer or unknown primary tumour. In the UK about 8,600 people are diagnosed with CUP in the UK each year.
Sometimes secondary cancers are found in one or more parts of the body, but despite several tests, clinicians can't find the primary tumour. If tests show that you have a cancer that has spread, but your clinicians can’t find the primary tumour, it’s called a malignancy of unknown primary origin (MUO).
CUP occurs in 2 out of every 100 cancers diagnosed (2%). CUP can develop at any age but almost 60% are in people over the age of 75.
Why is the primary cancer difficult to find?
There are several reasons why the primary cancer may not be found:
- It might be too small to be detected on a scan
- the original tumour might have disappeared after spreading. This can happen if it did not get enough blood supply or if your immune system destroyed it, but the cancer had already spread to other parts of your body.
Investigation/Tests:
You will only be offered investigations if they are likely to make difference to your overall treatment or care. We will endeavour at all times to include you and your family in decisions regarding further tests.
Common tests are:
- X-rays
this takes lots of x-rays of an area of your body to create a detailed picture. The scan may last 10-30 minutes. You may be given a drink or an injection of dye beforehand. - MRI scan (magnetic resonance imaging) uses magnetism to build up a set of pictures instead of x-rays. You will be asked to lie flat inside the tunnel scanner, for sometimes up to an hour.
- PET scan (positron emission tomography) uses a small amount of special radioactive substance (tracer), usually injected into your blood stream. Tracers move through your body and collect in areas with higher activity, like areas with disease, such as cancer.
- Ultrasound scan, this is using sound waves to create a picture of an area inside your body. It involves putting gel onto the relevant area and then rubbing a small device over the area.
- Blood tests, taking a small sample of blood from your arm
- Biopsy, this involves taking a small tissue sample from cancer. If you require a biopsy, you will be given more information on the procedure.
- CT scan (computerized tomography)
What are the treatment options for Cancer of Unknown Primary?
Suitability for treatment and the type of treatment is usually assessed by the Multi-Disciplinary Team (MDT) depending on the evidence, the patient’s performance status (PS), general health and quality of life. Possible treatments include chemotherapy, radiotherapy or targets cancer drugs.
What types of support are available?
It can be very shocking to be told that you have cancer that has spread. Not knowing where the cancer started can make the news even harder to take in. Your treatment team, including your specialist cancer nurse, will do all they can to support you and your family.
If you are diagnosed with CUP in Frimley Health Foundation Trust, you will be referred to the Acute Oncology Service (AOS). The Acute Oncology Service is here to help answer your questions, address your concerns and support you through this difficult time.
To help support you, you will be offered a Holistic Needs Assessment (HNA) and asked to return this information to your key worker or Cancer Support Worker. This gives you a chance to think about your concerns, discuss possible solutions and develop a care plan for your needs. If you have identified concerns on your HNA checklist, you will receive a call from the Acute Oncology team to discuss this and work with you to make a plan to help with your care and support needs.
Throughout the investigation phase, the Acute Oncology team will be your key worker. This means you can contact them with any questions you may have.
Contact number: 0300 6134752 (FPH), 0300 6153445 (WPH) (8.30- 4.00pm. Monday to Friday).
For Emergency call: 111/999
Further information and support:
You can find out more from the following weblinks:
Macmillan Cancer Support: www.
Cancer of Unknown Primary Foundation/Jo’s Friends: www.
Contact us
If you have any queries relating to this information, please contact the Cancer care service.
About this information
Service:
Cancer care
Reference:
HH/054
Approval date:
3 October 2024
Review date:
1 November 2026
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.