Materiały źródłowe

• #1 Carcinoma of Unknown Primary Treatment – NCI

  https://www.cancer.gov/types/unknown-primary/patient/unknown-primary-treatment-pdq

  Carcinoma of unknown primary (CUP) is a rare disease in which malignant (cancer) cells are found in the body but the place the cancer began is not known. […] The signs and symptoms of CUP are different, depending on where the cancer has spread in the body. […] Because the place where the cancer started is not known, many tests and procedures may be done to search for the primary cancer. […] If tests show there may be cancer, a biopsy is done. […] When the type of cancer cells or tissue removed is different from the type of cancer cells expected to be found, a diagnosis of CUP may be made. […] Tests and procedures used to find the primary cancer depend on where the cancer has spread. […] Certain factors affect prognosis (chance of recovery). […] For most patients with CUP, current treatments do not cure the cancer. Patients may want to take part in one of the many clinical trials being done to improve treatment.

• #2 Carcinoma of unknown primary – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/carcinoma-unknown-primary/symptoms-causes/syc-20370683

  Carcinoma of unknown primary is a diagnosis healthcare professionals give when they can’t find where a cancer started. A carcinoma of unknown primary is an advanced cancer that has spread in the body. […] Healthcare teams often use the kind of primary cancer you have to help decide on the treatment. If you’re found to have carcinoma of unknown primary, this piece of information is missing. Your healthcare team will work to find out what kind of cancer you have. […] Carcinoma of unknown primary care at Mayo Clinic.

• #3 What is Cancer of Unknown Primary? Symptoms, Risk Factors & Treatments | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/cancer-of-unknown-primary.html

  Cancer of unknown primary is a disease that has metastasized (spread) from another part of the body. The place where it began, also called the primary site, is unknown. These cases make up about 2% to 5% of cancers diagnosed in the United States. Thanks to better diagnostic tests, though, they are becoming less common. […] Cancer of unknown primary often is challenging because it tends to be aggressive and has often spread to many parts of the body before it is found. In addition, because origin of cancer is unknown, it may be more challenging to choose the best treatment. […] At MD Andersons Gastrointestinal Center, we have the depth of expertise to provide customized treatment for each patient with cancer of unknown primary (CUP). Our pathology experts have significant experience in evaluating cancer of unknown primary. We use advanced diagnostic methods to pinpoint the origin of CUP tumors, which are then treated by a team of renowned specialists.

• #4

  http://waocp.com/journal/index.php/apjcc/article/view/855

  Cancer of unknown primary origin (CUP) is a heterogeneous group of cancers defined by the presence of metastatic disease with no identified primary. CUP has been reported to comprise approximately 2% to 5% of all cancer cases. […] Patients presenting with metastatic carcinoma with unknown primary have poor outcomes. These patients need a patient-centred, streamlined, rapid diagnostic pathway. The outcome of these patients with standard chemotherapy remains poor. […] Patients with unknown primary must be subjected to all basic investigations that would lead to better management and early treatment consequently better survival of these patients. Advanced imaging modalities and immunhistochemistry facilities should be made available in all tertiary care hospitals in our country for better assessment and management of these patients.

• #5

  http://www.bccancer.bc.ca/health-professionals/clinical-resources/cancer-management-manual/primary-unknown/primary-unknown

  Patients with metastatic cancer of unknown primary site (primary unknown) have a histological or cytologically documented cancer, but no primary site identified after careful clinical history, full physical examination (including pelvic and rectal exam) and chest radiograph. The management of metastatic cancer when the site of origin of the malignancy is unknown requires a systematic approach. […] Triage of patients to Radiation or Medical Oncology will depend on the symptoms needing palliation and the site(s) involved. For example, patients with brain metastases or painful bone metastases are usually treated by a radiation oncologist and patients with liver, lung or soft tissue disease are managed by a medical oncologist. A specific clinic or conference for tumours of unknown primary does not exist at this time, but difficult cases are discussed in a multi-disciplinary fashion by the appropriate specialties.

• #6 Carcinoma of Unknown Primary Treatment (PDQ®) – PDQ Cancer Information Summaries – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK65811.2/?report=printable

  This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of carcinoma of unknown primary. It is intended as a resource to inform and assist clinicians in the care of their patients. […] The prognosis for patients with CUP is poor. As a group, the median survival is approximately 3 to 4 months with less than 25% and 10% of patients alive at 1 and 5 years, respectively. […] Although only a minority of patients will have curable disease or a disease for which there is substantial palliative benefit, the appropriate use of special diagnostic pathology and selected radiologic studies will identify patients for whom directed therapy will provide the best possible chance for response. […] Patients who have poorly differentiated carcinomas with or without serologic or histologic evidence of beta human chorionic gonadotropins or alpha-fetoprotein should be treated with intensive chemotherapy as used in the treatment of disseminated germ cell tumors.

• #7 Cancer of unknown primary site

  https://www.racgp.org.au/afp/2015/september/cancer-of-unknown-primary-site

  Cancer of unknown primary (CUP) is the diagnosis given to patients with metastatic cancer with no known site of origin. […] This review summarises the current knowledge regarding the epidemiology, diagnosis, treatment and care of CUP. […] Patients with CUP have high care needs, which are often unmet and in excess of those with known primary site. […] Data from DVA clients show higher rates of general practice consultations, palliative care, hospitalisations and emergency department visits in the 3 months after diagnosis, compared with those with metastatic cancer of known primary site. […] Patients with CUP will benefit from an integrated care plan, regardless of whether they receive curative or palliative, end-of-life care. […] This care plan must include psychological assessment.

• #8 Carcinoma of Unknown Primary (CUP): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/6139-carcinoma-of-unknown-primary

  You may benefit from mental health support. Research shows people with carcinoma of unknown primary are more likely to have depression and anxiety than others who have metastatic cancer. You may benefit from mental health support like talking to a counselor or psychologist. […] Cleveland Clinic treats all types of carcinoma. We offer the latest options for diagnosis and personalized treatment focusing on you and your needs.

• #8 Carcinoma of Unknown Primary (CUP): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/6139-carcinoma-of-unknown-primary

  Carcinoma of unknown primary (CUP) is when cancer spreads from one area of your body, but healthcare providers cant find the original cancer. Providers treat carcinoma of unknown primary based on what they learn from tests. These tests indicate the most likely type of cancer. […] Providers use information about the primary tumor to develop treatment that targets the metastatic cancer or secondary cancer. But they can also treat carcinoma of unknown primary even when they cant find the primary tumor. Test results may give them enough information to treat CUP with specific anticancer medication. […] Your cancer care team will develop a treatment plan based on what they learn about the cancer. In some cases, pathologists can identify the primary cancer. In that case, your care team will tailor treatment to that cancer type. Your team may do more general treatment if tests dont identify the primary cancer. Your treatment may include: Surgery. You may have cancer surgery to remove cancer that only affects one area of your body. Chemotherapy. Your care team may recommend chemotherapy if it appears you have cancer in more than one area of your body. Hormone therapy. Some cancers need hormones to grow. Hormone therapy works by blocking cancerous cells access to certain hormones. Immunotherapy. This treatment uses your immune system to find and kill cancer cells. Radiation therapy. This is treatment for cancer that appears to be in one area of your body. You may have external beam radiation therapy or internal radiation. Targeted therapy. You may have this treatment if tests reveal the original cancer type.

• #9 Carcinoma of unknown primary | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/carcinoma-unknown-primary

  Palliative care is a special type of healthcare that helps people with serious illnesses feel better. If you have cancer, palliative care can help relieve pain and other symptoms. A team of healthcare professionals give palliative care. This can include doctors, nurses and other specially trained professionals. Their goal is to improve the quality of life for you and your family. […] Coping with carcinoma of unknown primary often involves learning to cope with distress. Many people with this cancer have distress. Symptoms of distress include being worried, scared, sad or angry about your cancer. These feelings can happen because this diagnosis comes with many questions. A person with carcinoma of unknown primary may have many tests and never know exactly where the cancer started. Sometimes it’s not clear which treatment is the best.

• #9 Carcinoma of unknown primary | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/carcinoma-unknown-primary

  Carcinoma of unknown primary is a diagnosis healthcare professionals give when they can’t find where a cancer started. A carcinoma of unknown primary is an advanced cancer that has spread in the body. […] Healthcare teams often use the kind of primary cancer you have to help decide on the treatment. If you’re found to have carcinoma of unknown primary, this piece of information is missing. Your healthcare team will work to find out what kind of cancer you have. […] To diagnose carcinoma of unknown primary, a healthcare professional might start by examining your body. Other procedures might include imaging tests and a biopsy. If your healthcare team finds carcinoma of unknown primary, they’ll do other tests to find the place where the cancer started. […] Treatment for carcinoma of unknown primary often involves medicines. Cancer treatments that use medicines include chemotherapy, immunotherapy and targeted therapy. Carcinoma of unknown primary is a cancer that has spread in the body. Cancer medicines can travel through the body and kill cancer cells. Sometimes healthcare professionals use other treatments, such as surgery and radiation therapy.

• #10 Cancer of unknown primary site

  https://www.racgp.org.au/afp/2015/september/cancer-of-unknown-primary-site

  Coping with a diagnosis of metastatic cancer is more difficult when the primary site is unknown, and adds to distress, hopelessness, somatisation, anxiety and depression. […] GPs have an important role in ensuring continuity of care, communication and collaboration between specialists, and communication with the patient and family. […] This would be aided by Australian guidelines and policies for the follow-up and care of patients with CUP.

• #11

  https://link.springer.com/article/10.1007/s00520-022-07228-7

  CUP patients have unmet medical communication/information needs and greater uncertainty in illness but do not differ in health-related quality of life domains compared to patients with advanced cancer of a known primary. […] More than half of the patients with CUP reported not receiving any written information about their cancer. […] The lack of adequate information for patients with CUP may also be attributed to significantly higher uncertainty in illness compared to non-CUP control patients. […] These findings may inform future resources for patients with CUP and the implementation of new clinical care guidelines that include the dissemination of patient resources to this group especially post diagnosis. […] Given that uncertainty is considered to be a major stressor that people seek to reduce, interventions that aim to minimise uncertainty in CUP patients should target optimizing the provision of high quality information tailored to CUP patients individual needs, especially for those that have the greatest information needs.

• #12 Carcinoma of Unknown Primary – North Tees and Hartlepool NHS Foundation Trust

  https://www.nth.nhs.uk/resources/carcinoma-of-unknown-primary/

  This leaflet will tell you about Carcinoma of Unknown Primary and the care you will receive. […] You will be referred to the Carcinoma of Unknown Primary Team (CUP Team). […] The Carcinoma of Unknown Primary Team is made up of a group of Healthcare Professionals who have specialist knowledge and expertise in the management of patients with this condition. […] Nurse Specialists who will provide you with information and support. They will inform you about any possible tests, treatments and provide a point of contact for you if you have any questions. […] A Nurse Specialist will be assigned as your key worker. They will be your main point of contact in the hospital. […] The Nurse Specialists have specific knowledge about patients with Carcinoma of Unknown Primary and the treatments they may be offered. […] They will keep you informed of decisions made about treatment and make sure your views will be taken into account. They will offer you support in coming to terms with your diagnosis and answer any questions you may have.

• #13 Carcinoma of Unknown Primary (CUP) | Hull University Teaching Hospitals NHS Trust

  https://www.hey.nhs.uk/patient-leaflet/carcinoma-of-unknown-primary-cup/

  Cancer of unknown primary can be referred to in different ways: […] Carcinoma of Unknown Primary. […] Supportive or palliative care with medicines to control your symptoms can be an important part of treatment for people with CUP. […] If you are diagnosed with CUP you will be allocated a key worker to help support you. […] Your key worker will help co-ordinate your care and will try to help answer your questions, address your concerns and support you through this difficult time. […] If you decide to choose this option, you will be offered palliative care. This aims to control your symptoms and help you to keep your quality of life.

• #14 Polikliniek Primaire Tumor Onbekend (PTO) | AVL

  https://www.avl.nl/en/preparing-for-your-appointment/departments-and-centers/cancer-of-unknown-primary-clinic-cup/

  Over 1300 people in the Netherlands are diagnosed with cancer of unknown primary (CUP) every year. […] In most cases, this means that it is not possible to determine the best treatment option because most cancer treatments are tied to a specific tumor type. […] At the Netherlands Cancer Institute, we have a dedicated team of experts who specialize in care for patients with CUP. […] The NKI has a specialized CUP care team. Patients with CUP can come to the NKI for a second opinion with our CUP team. […] Our CUP care team consists of highly committed expert medical oncologists (internists) and pathologists who collaborate closely and share even the smallest points of reference that could potentially lead to the discovery of the primary tumor. […] After an elaborate analysis of all diagnostic examinations, your medical oncologist will discuss a potential treatment plan with you.

• #15 Patient and carer reports of care in metastatic presentation of cancer of unknown primary origin | BMJ Supportive & Palliative Care

  https://spcare.bmj.com/content/2/Suppl_1/A46.2

  Patient and caregiver experiences of cancer of unknown primary (CUP) have been under-researched. Common challenges include diagnostic uncertainty, poor prognosis and difficulty in identifying this population. […] This small study highlights the distress experienced, but also demonstrates that good care is achievable. Palliative care has a particular contribution to make not only in optimising symptom control, but in addressing key issues associated with this cancer presentation: co-ordinating investigations and care, and providing skilled communication where diagnosis is uncertain.

• #16 Carcinoma of unknown primary – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/carcinoma-unknown-primary/diagnosis-treatment/drc-20433758

  To diagnose carcinoma of unknown primary, a healthcare professional might start by examining your body. Other procedures might include imaging tests and a biopsy. If your healthcare team finds carcinoma of unknown primary, they’ll do other tests to find the place where the cancer started. […] Our caring team of Mayo Clinic experts can help you with your carcinoma of unknown primary-related health concerns. […] Treatment for carcinoma of unknown primary often involves medicines. Cancer treatments that use medicines include chemotherapy, immunotherapy and targeted therapy. Carcinoma of unknown primary is a cancer that has spread in the body. Cancer medicines can travel through the body and kill cancer cells. […] Palliative care is a special type of healthcare that helps people with serious illnesses feel better. If you have cancer, palliative care can help relieve pain and other symptoms. A team of healthcare professionals give palliative care. This can include doctors, nurses and other specially trained professionals. Their goal is to improve the quality of life for you and your family. […] When palliative care is used along with other treatments, people with cancer may feel better and live longer.

• #17 5 Innovative Cancer of Unknown Primary Treatment Options | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/cancer-of-unknown-primary/cancer-of-unknown-primary-treatment.html

  Your treatment at MD Anderson for a cancer of unknown primary (CUP) is individualized to provide the best options with the least impact on your body. […] Because each patient and each cancer of unknown primary is one of a kind, we tailor your treatment to match your needs. Our team approach ensures that some of the best and brightest minds work together to provide optimal care. […] Your treatment for cancer of unknown primary will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms. […] Surgery may be used if the cancer is in only one area, such as the lymph nodes or one organ. The type of surgery depends on where the CUP is located. Surgery may be combined with chemotherapy or radiation therapy.

• #18 Treatments for cancer of unknown primary | Canadian Cancer Society

  https://cancer.ca/en/cancer-information/cancer-types/cancer-of-unknown-primary/treatment

  Your healthcare team will create a treatment plan just for you. The plan is based on your health and specific information about the cancer. What you want is also important when planning treatment. […] Treatments for cancer of unknown primary (CUP) may be based on where cancer is found and where it may have started. […] Cancer of unknown primary (CUP) is usually treated with chemotherapy. […] Cancer of unknown primary (CUP) is often treated with surgery. […] Cancer of unknown primary (CUP) is sometimes treated with radiation therapy. […] Cancer of unknown primary (CUP) is sometimes treated with hormone therapy. […] Cancer of unknown primary (CUP) is sometimes treated with targeted therapy. […] Follow-up is an important part of care for cancer of unknown primary (CUP). It often involves regular tests and visits with the healthcare team.

• #19 Cancer of Unknown Primary Treatment | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/cancer-unknown-primary-origin/cancer-unknown-primary-treatment

  Medical oncologist Eileen OReilly treats cancer of unknown primary with chemotherapy and other drugs. […] At Memorial Sloan Kettering, care for cancers of unknown primary is managed by a team of doctors. Each member specializes in using chemotherapy, surgery, radiation therapy, or other therapies to treat cancers of unknown primary. This collaborative approach ensures that every person we care for gets the treatment or combination of treatments that best address their condition. […] Because cancer of unknown primary is by definition a cancer that has spread from a primary site, the disease is already at an advanced stage by the time it is diagnosed. Although there are no standard treatments for cancers of unknown primary, chemotherapy is usually the main treatment. […] Chemotherapy is the most common treatment for people with cancer of unknown primary. Given by IV or as a pill, chemotherapy destroys cancer cells throughout the body. This includes areas where cancer may not have been found. Chemotherapy is used to shrink tumors and relieve the symptoms caused by cancer. In rare cases, it can eliminate tumors so that no further treatment is necessary.

• #20 Metastatic Cancer With Unknown Primary Site Treatment & Management: Medical Care

  https://emedicine.medscape.com/article/280505-treatment

  The most effective chemotherapy regimens for this group of patients involve combination therapy with a platinum compound (cisplatin or carboplatin) and a taxane (preferably paclitaxel). […] Docetaxel and carboplatin chemotherapy was found to be convenient, safe and effective outpatient palliative treatment for CUP. […] Patients in whom combination therapy fails may benefit from single-agent treatment with gemcitabine with median time to progression of 5 months. […] A subsequent trial found that empiric treatment with paclitaxel, carboplatin, bevacizumab, and erlotinib is effective and well tolerated as first-line treatment for patients with CUP.

• #21 5 Innovative Cancer of Unknown Primary Treatment Options | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/cancer-of-unknown-primary/cancer-of-unknown-primary-treatment.html

  MD Anderson offers the most up-to-date and advanced chemotherapy options for CUP. […] MD Anderson provides the very latest radiation treatments, including: […] MD Anderson is among just a few cancer centers in the nation that are able to offer targeted therapies for some types of cancer of unknown primary. These innovative new drugs stop the growth of cancer cells by interfering with certain proteins and receptors or blood vessels that supply the tumor with what it needs to grow. […] Cancer of unknown primary is treated in our Gastrointestinal Center.

• #22 Cancer of Unknown Primary Treatment | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/cancer-unknown-primary-origin/cancer-unknown-primary-treatment

  When possible, doctors at Memorial Sloan Kettering choose a chemotherapy regimen that is effective in treating the organ or part of the body where we suspect the cancer began. Even when the primary site or part of the body cannot be identified, we customize the chemotherapy regimen for each person we care for after determining the type and appearance of the cancer cells, where the cancer has spread, and the individuals overall health. […] Surgery is often the treatment of choice for people with a tumor that is confined to the organ where it began. But because cancer of unknown primary has already spread, surgery does not usually cure the cancer. […] When a tumor of unknown primary is found in only one organ or lymph node, or if there are specific symptoms related to the site of the tumor, our doctors may recommend surgery. If the cancer is suspected to have begun in the breast, a mastectomy (surgical removal of the breast) may be required to ensure that all of the breast cancer cells have been removed. When surgery is used to treat cancer of unknown primary, it is usually followed by chemotherapy or radiation therapy to eliminate any cancer cells that may remain.

• #23

  https://healthlibrary.tidelandshealth.org/Conditions/Cancer/Specific/Carcinoma/subTopic.pg

  Cancer of unknown primary (CUP) is cancer that starts in an unknown area and has already spread by the time it’s diagnosed. […] Being told you have cancer of unknown primary (CUP) can be scary, and you may have many questions. But you have people on your healthcare team to help. […] If your healthcare provider thinks you might have cancer of unknown primary (CUP), you will need certain exams and tests to be sure. These tests will be used to try to find the place the cancer started. […] You may get just 1 type of treatment or a combination of treatments. Treatment may include chemotherapy, radiation therapy, hormone therapy, or surgery. […] Chemotherapy can shrink tumors. It can also help ease symptoms the cancer is causing. It may even make some tumors go away. […] Radiation may be used to treat the symptoms of cancer of unknown primary (CUP). Sometimes radiation may also be used to cure the cancer if it hasn’t spread too far.

• #24 Carcinoma of Unknown Primary Treatment (PDQ®) – PDQ Cancer Information Summaries – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK65811.2/?report=printable

  The most common primary site for isolated axillary metastasis is the breast. Mammography should be performed in all patients with isolated axillary-nodal metastasis. […] In addition to the above situations, significant palliation can be achieved in certain instances in patients with CUP. Breast, prostate, ovarian, and thyroid cancers are all treatable malignancies, even when metastatic, and they represent approximately 15% of all CUP tumors.

• #25 Cancer of Unknown Primary Treatment | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/cancer-unknown-primary-origin/cancer-unknown-primary-treatment

  Radiation therapy is only used to control tumors that cannot be surgically removed or when cancer of unknown primary spreads to the spine and interferes with neurologic function. […] Genetic testing using MSK-IMPACT can help doctors identify people with tumors that are likely to respond to immunotherapy or targeted therapies through a clinical trial.

• #26 Carcinoma of Unknown Primary – Missouri Cancer Associates

  https://missouricancer.com/cancer_type/carcinoma-of-unknown-primary/

  Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. […] New types of treatment are being tested in clinical trials. […] Patients may want to think about taking part in a clinical trial. […] For some patients, taking part in a clinical trial may be the best treatment choice. […] Patients can enter clinical trials before, during, or after starting their cancer treatment.

• #27 Cancer of Unknown Primary Site (CUPS) | Mays Cancer Center

  https://cancer.uthscsa.edu/cancer-care/types-and-treatments/cancer-unknown-primary-site-cups

  We personalize your treatment plan using all the cancer therapies at our disposal, many which are among the latest available. Your treatment plan may also include: […] Chemotherapy is usually the primary treatment for CUPS. We use research-based cancer-destroying drugs and protocols that doctors have used to treat CUPS for decades. […] We may recommend other cancer drugs, such as targeted therapies, that deactivate specific molecules inside cancer cells to stop them from spreading. […] Your treatment options may include new cancer drugs, if you are eligible. Researchers are actively exploring new targeted therapy and immunotherapy in ongoing clinical trials. Your care team will explain how available clinical trials may enhance your treatment.

• #28 Palliative Care for a Cancer of Unknown Primary | American Cancer Society

  https://www.cancer.org/cancer/types/cancer-unknown-primary/treating/palliative-care.html

  Some cancers of unknown primary can be treated effectively or even cured, but most are advanced cancers for which treatments are unlikely to provide long-term benefits. […] Its very important that people with advanced cancer of unknown primary (CUP) are aware that even if the cancer cant be cured, there are treatments available to help prevent or relieve pain and other symptoms. Many patients with CUP may benefit from palliative care as part of their treatment plan. Palliative care includes supportive care managed by your care team, such as relief from symptoms, pain, and stress. Its meant to improve quality of life for patients and their families. Treatment to control the cancer may also be included in a supportive care plan. […] Pain is a significant concern for patients with cancer of unknown primary. There are proven ways to relieve pain due to cancer of unknown primary using a combination of medicines and, in some cases, surgical procedures. Patients should not hesitate to take advantage of these treatments, which means they must tell their doctors if they have pain. Otherwise the doctor cant help. For most patients, treatment with morphine or drugs related to it (called opioids because they are related to opium) can reduce pain considerably while still allowing them to function well. For the treatment to be effective, the pain medicines must be given regularly on a schedule, not just when the pain becomes severe. Several long-acting opioid drugs have been developed that need only to be given once or twice a day.

• #29 Polikliniek Primaire Tumor Onbekend (PTO) | AVL

  https://www.avl.nl/en/preparing-for-your-appointment/departments-and-centers/cancer-of-unknown-primary-clinic-cup/

  In certain cases and after careful deliberation, we may decide not to start a treatment, in which case your medical oncologist will discuss options for palliative treatment with you. […] The CUP care team at the Netherlands Cancer Institute excels at CUP care. […] Our CUP team is experienced in palliative care and includes pain specialists as well as psychological support. […] Researchers are actively investigating CUP.

• #30 Cancer of Unknown Primary: Newly Diagnosed | UMass Memorial Health

  https://www.ummhealth.org/health-library/cancer-of-unknown-primary-newly-diagnosed

  Being told you have cancer of unknown primary (CUP) can be scary, and you may have many questions. But you have people on your healthcare team to help. […] To decide the best course of treatment, your healthcare provider needs to learn as much as they can about the cancer. Even if they can’t figure out where the cancer first started, there are other things that can help guide treatment, like tumor markers and gene or protein changes in the cancer cells. […] Other members of your team will be oncology nurses, a social worker, dietitian, counselor, pharmacist, and more. They’ll answer any questions you have. Theyll help you through each of the steps youll take before, during, and after treatment. […] Your team will let you know what tests you need and the results of those tests. Theyll guide you in making treatment decisions. Theyll also help prepare you and your loved ones for whats ahead. […] Coping with cancer can be very stressful. Talk with your healthcare team about seeing a counselor. They can refer you to someone who can help. You can also visit support groups to talk with other people coping with cancer. Ask your healthcare team about local or online support groups.

• #31 Coping With Cancer of Unknown Primary – Fact Sheet

  https://www.cancercare.org/publications/234-coping_with_cancer_of_unknown_primary

  Cancer of unknown primary occurs when the cells found in the body begin to change and grow uncontrollably, forming a tumor (also called a nodule), which can be either cancerous or benign, but the source of the cancer cannot be found. […] There are a wide range of treatments for cancer of unknown primary, including surgery, radiation therapy, hormone therapy, targeted therapy and chemotherapy. […] Your doctors and nurses are the central part of your team. It also can include pharmacists, oncology social workers, counselors and more. They all help you make decisions about your care. […] Cancer may not just affect yourself, but everyone around you. It is important to take care of your feelings. You may find emotional support from friends, family and loved ones. There are also many organizations, such as CancerCare, that provide support services to help people affected by cancer. […] CancerCare provides one-on-one counseling and support groups to connect you with others in a safe and supportive environment. We can also help find other resources to help you in many ways.

• #32 Treating a Cancer of Unknown Primary | American Cancer Society

  https://www.cancer.org/cancer/types/cancer-unknown-primary/treating.html

  If youve been diagnosed with a cancer of unknown primary, your cancer care team will discuss your treatment options with you. Its important that you think carefully about each of your choices. Weigh the benefits of each treatment option against the possible risks and side effects. […] Treatment for a cancer of unknown primary (CUP) may include: Surgery for a Cancer of Unknown Primary, Radiation Therapy for a Cancer of Unknown Primary, Chemotherapy for a Cancer of Unknown Primary, Hormone Therapy for a Cancer of Unknown Primary, Targeted Therapy for a Cancer of Unknown Primary, Other Drugs for a Cancer of Unknown Primary. […] Often, CUP is too advanced to be cured, and the goal may be to shrink the cancer for a time, in hopes of improving symptoms and helping you live longer. This treatment is considered palliative or supportive care, because its meant to relieve symptoms such as pain, but is not expected to cure the cancer.

• #33 Treating a Cancer of Unknown Primary | American Cancer Society

  https://www.cancer.org/cancer/types/cancer-unknown-primary/treating.html

  Its important to discuss all of your treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs. […] People with cancer need support and information, no matter what stage of illness they may be in. Knowing all of your options and finding the resources you need will help you make informed decisions about your care. […] Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms. […] Some people, especially if the cancer is advanced, might not want to be treated at all. There are many reasons you might decide not to get cancer treatment, but its important to talk to your doctors as you make that decision. Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms. […] People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life.

• #34 Carcinoma of Unknown Primary Treatment – NCI

  https://www.cancer.gov/types/unknown-primary/patient/unknown-primary-treatment-pdq

  There are different types of treatment for patients with carcinoma of unknown primary (CUP). […] Four types of standard treatment are used: Surgery, Radiation therapy, Chemotherapy, Hormone therapy. […] Treatment for carcinoma of unknown primary may cause side effects. […] Patients may want to think about taking part in a clinical trial. […] Treatment for recurrent carcinoma of unknown primary is usually within a clinical trial.

• #35

  http://www.bccancer.bc.ca/health-professionals/clinical-resources/cancer-management-manual/primary-unknown/primary-unknown

  If empiric chemotherapy is considered, the clinician should first decide whether it is wise for a given individual. Patients with major co-morbid cardiovascular, metabolic or other diseases which are actively symptomatic may well deteriorate more quickly under the added stress of chemotherapy. Patients with poor performance status (bed or chair-ridden most of the day) are unlikely to respond to systemic chemotherapy. Cytotoxic agents should be reserved for those patients who are sufficiently young and fit to permit a reasonable judgment that the unavoidable toxicities of such agents are worth enduring for a 20%-30% chance of a short-lived remission. […] Once therapy has been completed patients will return to their referring physicians for continued follow-up. Most patients should be seen on an intermittent basis to check for symptoms or findings of obvious progressive disease. Routine follow-up investigations would generally not be required unless the patient becomes symptomatic since the overall approach is palliative in nature.

• #36 Treatment for cancer of unknown primary (CUP) | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/cancer-unknown-primary-cup/treatment

  The main treatments for cancer of unknown primary (CUP) are targeted cancer drugs or chemotherapy. […] You may also have treatment to control any symptoms you are experiencing. […] Treatment to control symptoms is also called palliative care. The aim of palliative treatment is to relieve symptoms and improve your quality of life. […] After treatment for cancer of unknown primary (CUP), you might have regular follow up appointments.

• #37 Cancers of unknown primary diagnosed during hospitalization: a population-based study | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-017-3083-1

  Cancers of Unknown Primary (CUP) are the 3-4th most common causes of cancer death and recent clinical guidelines recommend that patients should be directed to a team dedicated to their care. […] Our aim was to inform the care of patients diagnosed with CUP during hospital admission. […] Patients with a diagnosis of CUP are usually diagnosed during unplanned hospital admissions and have very poor survival. To ensure that patients with CUP are quickly identified and directed to optimal care, increased surveillance and rapid referral pathways will be required. […] There is a paucity of evidence on patterns of hospital care for patients with CUP and therefore on the capacity to better identify patients so that they might be directed to specialist teams. […] Given the poor outcomes of patients admitted to hospital with CUP, is there scope for better primary and secondary prevention? Current understanding of the underlying biology and pathogenesis of CUP is incomplete; therefore, the possibility of detecting CUP earlier is uncertain.

• #38 Cancers of unknown primary diagnosed during hospitalization: a population-based study | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-017-3083-1

  Supportive and palliative care may therefore be key contributions that specialist CUP teams can offer patients. For those patients who present with more favourable disease, however, early effective treatment is a priority. Further research on investigations prior to diagnosis may help to inform more efficient diagnostic pathways that could benefit patients in either prognostic group.

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