Materiały źródłowe

• #1 Detecting undetectable – epidemiology, etiology, and diagnosis of carcinoma of unknown primary – systematic review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/37406274/

  Carcinoma of unknown primary (CUP) is a heterogeneous group of oncological diseases in which it is impossible to determine the primary tumor. The incidence is 3-5% of oncologic patients, but the survival time varies from 6 weeks to 5 months. […] The detailed diagnostics should be performed in highly specified centers to establish an accurate diagnosis and to initiate personalized treatment. Majority of patients are diagnosed with adenocarcinoma (70%), undifferentiated carcinoma (20%), squamous cell or transitional cell/uroepithelial carcinoma (5-10%), neuroendocrine tumor (5%) and with minor incidence other histological types, including melanoma.

• #1 Key Statistics for Cancers of Unknown Primary | American Cancer Society

  https://www.cancer.org/cancer/types/cancer-unknown-primary/about/key-statistics.html

  The exact number of cancers of unknown primary (CUP) diagnosed each year is unknown, because some cancers start out being diagnosed as unknown primary, but the primary site is found later. Still, the American Cancer Society estimates that about 37,370 cases of cancer of unknown primary will be diagnosed in 2025 in the United States. This number represents about 2% of all cancers. […] As more sophisticated lab tests become available to determine where a cancer started, the number of cancers of unknown primary may go down.

• #1 Cancer of unknown primary incidence statistics | Cancer Research UK

  https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cancer-of-unknown-primary/incidence

  Cancer of unknown primary is the 15th most common cancer in the UK, accounting for 2% of all new cancer cases (2017-2019). […] In females in the UK, cancer of unknown primary is the 11th most common cancer (2% of all new female cancer cases). In males in the UK, it is the 15th most common cancer (2% of all new male cancer cases). […] Cancer of unknown primary incidence rates (European age-standardised (AS) rate) for persons are significantly higher than the UK average in Scotland and Wales and significantly lower than the UK average in England and Northern Ireland. […] For cancer of unknown primary, there are few established risk factors therefore differences between countries largely reflect differences in diagnosis and data recording. […] In the UK in 2017-2019, on average each year almost 6 in 10 new cases (58%) were in people aged 75 and over.

• #1 Cancer of unknown primary incidence statistics | Cancer Research UK

  https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cancer-of-unknown-primary/incidence

  For cancer of unknown primary, like most cancer types, incidence increases with age. This largely reflects cell DNA damage accumulating over time. Damage can result from biological processes or from exposure to risk factors. […] Cancer of unknown primary European age-standardised (AS) incidence rates for females and males combined decreased by 60% in the UK between 1993-1995 and 2017-2019. […] The decrease was larger in males than in females. […] Cancer of unknown primary incidence rates have decreased overall in all broad age groups in females and males combined in the UK since the early 1990s. […] CUP incidence trends reflect improvements in data collection and diagnostic capabilities which mean identification of primary site is possible for more cancer cases, hence fewer cases are registered as CUP.

• #1 Cancer of unknown primary—Epidemiological trends and relevance of comprehensive genomic profiling

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6144156/

  CUP patients account for 0.9%-2.6% of all newly diagnosed cancer patients in Zurich. This is in line with earlier studies in other Swiss regions identifying CUPs as 2.3% of new cancer diagnoses. […] The higher ASR between 1981 and 1997 may be due to increased CUP awareness and more frequent use of imaging technologies. The subsequent decrease in ASR may be due to better imaging technologies including computer tomography, broader use of endoscopy, and better immunohistochemical tools in pathology, which has led to a significant reduction in diagnostic errors in general. […] Overall survival of CUP patients in Zurich has not improved over the last 34 years, which is similar to Sweden and the United States. […] Given poor prognosis and limited treatment options for patients with CUP, genomic profiling using NGS technologies may meet a clinical need. A large number of CUP patients could benefit from molecularly targeted therapies, because clinically relevant mutations are observed in 30%-85% of the CUP patients.

• #1 CUP Syndrome – Cancer of Unknown Primary — Onkopedia

  https://www.onkopedia.com/en/onkopedia/guidelines/cup-syndrome-2013-cancer-of-unknown-primary

  The incidence of CUP has been decreasing since the turn of the century in Western industrialized countries and is 4-15/100,000 inhabitants/year, corresponding to 1-3% of all cancer cases. […] According to RKI data, about three quarters of patients affected die within one year after diagnosis, and around 10% are alive after 5 years. […] Overall, mortality in CUP (unchanged in 2020 as compared to previous years) takes the 6th place (4.6%) of all cancer deaths in Germany. […] The peak age of onset is 53 to 62 years, and men are affected slightly more often than women (around 1.1:0.9). […] The ESMO guideline recommends the use of PET-CT additionally in singular metastases or oligometastatic disease, if there is a prospect of local ablative therapy in curative intention with surgery and / or radio(chemo)therapy. […] Evidence-based guidelines for follow-up in CUP syndrome are not available.

• #1 Metastatic Cancer With Unknown Primary Site: Practice Essentials, Pathophysiology, Epidemiology

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

  The exact incidence of cancer of unknown primary origin is not precisely known. It is almost certainly underreported, and its true incidence is most probably from 2% to 6% of all cancers diagnosed in the United States, and 2-9% of cancers diagnosed worldwide. […] The American Cancer Society estimates that 32,590 persons (16,810 males; 15,780 females) will be diagnosed with cancers of unspecified primary sites in the United States in 2023. This would suggest that cancer of unknown primary origin constitutes less than 2% of all cancers diagnosed in the United States. However, deaths due to cancer of unknown primary site are estimated to be 48,160 in 2023 (26,130 males; 22,030 females). This discrepancy between incidence and mortality is believed to be due to a lack of specificity in the listing of cause of death on death certificates. […] Most series reporting on or reviewing cancer of unknown primary origin patient groups give an approximate equal incidence for men and women. The median age at presentation for both men and women ranges from 59-66 years.

• #1 Cancer of unknown primary: a population-based analysis of temporal change and socioeconomic disparities | British Journal of Cancer

  https://www.nature.com/articles/bjc2013386

  Cancer of unknown primary (CUP) is the fourth most common cause of cancer death. […] The percentage of all cancers diagnosed as CUP has decreased over time comprising 2% of cancers since 2007. […] A higher proportion of CUP was diagnosed in the elderly, females, blacks and residents of less affluent or less educated counties. […] The percentage of cancers diagnosed as CUP is decreasing but prognosis remains poor, particularly in non-SCC CUP. However, significant socioeconomic disparities exist in diagnosis and survival, suggesting inequalities in access to diagnostic investigations and treatment. […] The proportion of cancer cases diagnosed as CUP decreased over time within all subgroups analysed. However, disparities between different socioeconomic groups are evident. […] Since the mid-1990s, the proportion of CUP cases was lower in areas of higher education and affluence, compared with less educated and poorer areas.

• #1 Cancer of unknown primary incidence statistics | Cancer Research UK

  https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cancer-of-unknown-primary/incidence

  The number of new cancers of unknown primary cases on average each year in the UK is projected to rise from around 7,500 cases in 2023-2025 to around 8,200 cases in 2038-2040. […] Cancers of unknown primary incidence rates are projected to fall by 13% in the UK between 2023-2025 and 2038-2040, to 9 cases per 100,000 people on average each year by 2038-2040. […] Some cancers of unknown primary have the location of their secondary/metastatic growth recorded. Most cancers of unknown primary in the UK do not have a specific location recorded (2016-2018). […] Cancer of unknown primary incidence rates (European age-standardised (AS) rates) in England in females are 58% higher in the most deprived quintile compared with the least, and in males are 65% higher in the most deprived quintile compared with the least (2013-2017). […] It is estimated that there are around 1,400 more cases of cancer of unknown primary each year in England than there would be if every deprivation quintile had the same age-specific crude incidence rates as the least deprived quintile.

• #1 Poorly differentiated cancer from an unknown primary site – UpToDate

  https://www.uptodate.com/contents/poorly-differentiated-cancer-from-an-unknown-primary-site

  Cancer of unknown primary site (CUP) is a relatively common clinical entity, accounting for approximately 2 percent of all invasive cancer diagnoses. […] Most CUP are adenocarcinomas and can be recognized by routine histologic examination. However, 20 to 25 percent of CUPs are poorly differentiated and cannot be precisely characterized by histologic examination. Approximately 80 percent of these poorly differentiated tumors have features of carcinoma and are termed „poorly differentiated carcinoma” after initial pathologic examination. […] Every attempt should be made to arrive at the most specific diagnosis possible, since the treatments for various cancers in this group can be quite different and may be curative in some patients. The diagnostic approach to poorly differentiated cancers of unknown primary site will be reviewed here, along with the prognostic and therapeutic implications.

• #1 Risk factors for cancer of unknown primary: a literature review | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-023-10794-6

  Cancer of Unknown Primary (CUP) is metastatic cancer with an unidentifiable primary tumour origin during life. It remains difficult to study the occurrence and aetiology of CUP. Hitherto, it is unclear whether risk factors are associated with CUP, yet identifying these factors could reveal whether CUP is a specific entity or a cluster of metastasised cancers from various primary tumour origins. Epidemiological studies on possible CUP risk factors were systematically searched in PubMed and Web of Science on February 1st, 2022. Studies, published before 2022, were included if they were observational human-based, provided relative risk estimates, and investigated possible CUP risk factors. A total of 5 casecontrol and 14 cohort studies were included. There appears to be an increased risk for smoking in relation to CUP. However, limited suggestive evidence was found to link alcohol consumption, diabetes mellitus, and family history of cancer as increased risks for CUP. No conclusive associations could be made for anthropometry, food intake (animal or plant-based), immunity disorders, lifestyle (overall), physical activity, or socioeconomic status and CUP risk. No other CUP risk factors have been studied. This review highlights smoking, alcohol consumption, diabetes mellitus and family history of cancer as CUP risk factors. Yet, there remains insufficient epidemiological evidence to conclude that CUP has its own specific risk factor profile.

• #1 Cancer of Unknown Primary Treatment (PDQ®) – NCI

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

  A review of five case control studies and 14 cohort studies found a clear increased risk of CUP with smoking. […] Conceptually, CUP is a type of tumor that tends to metastasize early, unlike more common cases, in which the primary tumor is apparent, with or without metastasis. […] The pathologist has a central role in the evaluation of CUP. A thorough evaluation of an adequate specimen for histological, immunohistochemical, molecular diagnostics, next-generation sequencing (NGS), and, when appropriate, electron microscopic evaluations provides the most important clues in the diagnosis of CUP. […] Clinical, pathological, and molecular genetic tests have two goals. The first is to identify tumors that are responsive to available therapies. The second is to identify novel targeted therapies that might be applicable to the particular genetic profile.

• #1 Cancer of unknown primary origin – Wikipedia

  https://en.wikipedia.org/wiki/Cancer_of_unknown_primary_origin

  Cancer of unknown primary origin (CUP) is found in about 3 to 5% of all people diagnosed with invasive cancer, and carries a poor prognosis in most (80 to 85%) of those circumstances. […] CUP sometimes runs in families. It has been associated with familial lung, kidney, and colorectal cancers, which suggests that these sites may often be the origin of unidentifiable CUP cancers. […] Around 9,800 people were diagnosed with cancer of unknown primary in the UK in 2011, and around 10,625 people died from the disease in 2012.

• #1 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. […] The cause of carcinoma of unknown primary often isn’t known. Healthcare professionals use this diagnosis when they find signs of cancer that has spread but can’t find where the cancer started. The place where a cancer started growing is called the primary cancer. […] The risk of carcinoma of unknown primary might be related to: […] Older age. This type of cancer happens most often in people older than 60. […] Family history of cancer. If a close relative had carcinoma of unknown primary, you may have an increased risk of this cancer. There also is some evidence that carcinoma of unknown primary happens more often in people with a family history of cancer that affects the lungs, kidneys or colon. […] Smoking cigarettes. People who smoke cigarettes may have a higher risk of carcinoma of unknown primary.

• #1 Frontiers | Does Cancer of Unknown Primary (CUP) Truly Exist as a Distinct Cancer Entity?

  https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2019.00402/full

  Cancer of unknown primary (CUP) designates an enigmatic cancer entity with histologic confirmation of malignancy from a metastasis but no identifiable primary tumor in spite of a thorough diagnostic work-up. […] CUP cases share an aggressive clinical course, atypical metastasis pattern, rapid progression of metastases, a generally poor response to chemotherapy and dismal outcome as distinct clinical features. […] The diligent diagnosis of CUP is warranted for clinical trials, making the eligibility process particularly laborious. […] In conclusion, we deem CUP a distinct cancer entity and the diagnosis accurate in most patient cases. […] CUP is diagnosed in malignancies, where metastases have been histologically confirmed, but where no primary site can be identified in spite of a comprehensive diagnostic work-up.

• #1 Cancer of Unknown Primary Treatment (PDQ®) – NCI

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

  A cancer of unknown primary (CUP) is defined as a biopsy-confirmed malignancy with no established primary site after pathological evaluation and radiographic studies. With the advent of comprehensive genomic profiling and positron emission tomography-computed tomography scanning, less than 1% of new cancer diagnoses are designated as CUP. […] The prognosis for patients with CUP is poor. Approximately 30% of patients are alive at 1 year. CUP is represented by a heterogeneous group of diseases, all of which have presented with metastasis as the primary manifestation. […] Survival is worse for patients with any of the following characteristics: adenocarcinoma or undifferentiated carcinoma histology, extranodal presentation, older age, hepatic or adrenal involvement, poor performance status, elevated serum lactate dehydrogenase (LDH).

• #1 Defining prognosis in Cancer of Unknown Primary (CUP) | Oncopedia

  https://www.oncopedia.wiki/contributions/defining-prognosis-in-cancer-of-unknown-primary

  Cancer of unknown primary (CUP) accounts for 2% of all human cancers and by definition is fraught with diagnostic and treatment challenges because the primary tumour is undefined in over 8085% of cases (JD Hainsworth et al. J Clin. Oncol. 2013). […] Diagnosing CUP, therefore, is especially challenging, and fewer than 20% of patients survive beyond 1 year following initial diagnosis. […] CUP is divided into unfavourable (80%) group with 2-10 months survival and favourable (20%) group with a median survival of more than 2 years. […] A Canadian open registry study of patient samples collected from 20002005 looked at survival outcome differences based on treatments using knowledge of the primary tumour site for patients with CUP and known primary site. Patients with a known primary had considerably better outcomes (median overall survival of 11.9 months) than those with an unknown site (1.9 months).

• #1 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

  The incidence of CUP has risen and then fallen over the past 50 years, possibly driven initially by greater diagnostic sensitivity detecting more metastatic disease and then latterly by better identification of the primary site reducing the number of unknown primaries. […] Worldwide, CUP are the 6th to 8th most common cancers, accounting for 2.35% of all cancer diagnoses but the 3rd to 4th most common cause of death from cancer. […] Survival is poor, with a median of 5.6 weeks. […] Survival is more favourable among patients whose disease mimics clinicopathological features of known metastatic cancers and responds to appropriate treatment (median survival 24 months) but the majority of patients (80-85%) respond poorly to treatment. […] The National Cancer Intelligence Network reported on routes to diagnosis of CUP between 2006 and 2010.

• #1 Cancer of unknown primary: a population-based analysis of temporal change and socioeconomic disparities | British Journal of Cancer

  https://www.nature.com/articles/bjc2013386

  The median survival of all CUP carcinoma patients was 3 months (range 0-30 months), with no improvement in the median survival over time in the overall cohort. […] The overall prognosis for patients diagnosed with CUP remains poor, with an overall median survival of 3 months. […] The lack of improvement in the survival over time in patients with non-squamous CUP may actually reflect a type of selection bias. […] The disparities demonstrated in this study highlight the need for policy interventions to ensure that the most vulnerable and disadvantaged patients with CUP have access to all available advances in diagnostic and therapeutic modalities.

• #1 Cancer of unknown primary—Epidemiological trends and relevance of comprehensive genomic profiling

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6144156/

  Cancer of unknown primary (CUP) is a distinct clinicopathological entity with poor prognosis, frequently resistant to chemotherapy. Comprehensive genomic profiling (CGP) by next-generation sequencing potentially identifies novel treatment options for CUP patients. The objective of this study was to determine incidence and survival trends and to discuss the value of CGP in CUP patients. […] ASR of CUP increased from 10.3 to 17.6 between 1981 and 1997 and decreased to 5.8/100 000 in 2014. Mean overall survival remained stable. Mortality was significantly lower for patients with squamous cell carcinoma (HR 0.48 [95% CI, 0.41-0.57]) and neuroendocrine carcinoma (0.75 [0.63-0.88]) and higher for unclassified neoplasms (1.25 [1.13-1.66]) compared to adenocarcinomas. […] CUP incidence decreased probably due to improved diagnostics, but mortality did not improve over the last 34 years. CGP testing may help to identify molecular signatures in CUP patients and enable targeted treatment.

• #1 Real-world data analysis of patients with cancer of unknown primary | Scientific Reports

  https://www.nature.com/articles/s41598-021-02543-1

  The OS according to disease extent is shown in Fig. 3b. The median OS duration was 34.6 months for localized disease and 6 months for disseminated disease, respectively. […] Although the overall survival outcome of CUP was poor, subgroups of patients who had localized disease treated with CCRT demonstrated favorable outcomes (median OS, 51.7 months). […] In our study, we used the OncoKB data for classification, and 10 (43.5%) out of 23 patients showed level 1, 2, or 3 alterations. […] In a study conducted in South Korea, 17 among 21 patients who underwent NGS showed possible clinical genomic alterations and only one received targeted therapy. […] The CUPISCO study (NCT03498521) is currently ongoing, which is a randomized trial comparing individualized targeted treatment or immunotherapy with standard platinum-based chemotherapy in patients with CUP.

• #1 Real-world data analysis of patients with cancer of unknown primary | Scientific Reports

  https://www.nature.com/articles/s41598-021-02543-1

  Cancer of unknown primary (CUP) is a heterogeneous malignancy in which the primary site of the tumor cannot be identified through standard work-up. The survival outcome of CUP is generally poor, and there is no consensus for treatment. […] Most patients with CUP have been included in unfavorable subsets and showed poor prognosis, with a median overall survival (OS) of 6 months. […] Despite recent advances in diagnostic techniques and treatment strategies, the characteristics of CUP and treatment patterns in real-world settings are not well-known. […] The clinical utility of tailored therapy is also yet to be established as there are few studies on how novel targeted therapies are being applied in clinical practice. […] The median OS of the study patients as a whole was 8.3 months. […] When divided according to the ECOG PS, those with ECOG PS 0 or 1 had a median OS duration of 13.3 months and those with ECOG PS greater than 1 had a median OS duration of 3.9 months.

• #1 Carcinoma of an Unknown Primary Site

  https://www.cancernetwork.com/view/carcinoma-unknown-primary-site

  Recommended evaluation includes a complete history; physical examination; chemistry profile; complete blood cell count; computed tomography scans of the chest, abdomen, and pelvis; and specific radiologic and/or endoscopic evaluation of symptomatic areas. […] In general, radiologic or endoscopic evaluation of asymptomatic areas is not productive and should be avoided. […] Approximately 80% of patients with cancer of unknown primary site do not fit into any of the favorable treatment subsets previously discussed. […] Improved diagnostic techniques, including panels of IHC stains and gene expression profiling, enable accurate prediction of the tissue of origin in the majority of patients with carcinoma of unknown primary site. […] All studies to date support the use of assay-directed, site-specific therapy as a new treatment paradigm.

• #1 Squamous cell carcinoma of unknown primary site

  http://www.aboutcancer.com/occult_squam_rvw_utd.htm

  Panendoscopy with systematic blind biopsies of mucosal sites likely to harbor occult tumors (eg, nasopharynx, base of tongue, pyriform sinus, tonsils) is the standard of care in many institutions for patients with metastatic squamous cell cancer in the cervical lymph nodes. […] When a primary site cannot be identified, patients with SCC of unknown primary site that involves the upper or mid cervical nodes should be treated according to guidelines for locally advanced SCC of the head and neck. […] A primary lung cancer should be suspected when lower cervical or supraclavicular nodes are involved. […] The vast majority (99 percent in one series) of patients with SCC involving inguinal lymph nodes have a detectable primary site in the genital or anorectal area (including the surrounding skin). […] Metastatic SCC in areas other than the cervical or inguinal lymph nodes usually represents metastasis from a primary lung cancer.

• #1 Management of an Unknown Primary Merkel Cell Carcinoma: A Case Report | Papadopoulou | Journal of Medical Cases

  https://www.journalmc.org/index.php/JMC/article/view/3004/2344

  Merkel cell carcinoma (MCC) represents a rare skin cancer associated with sun exposure. It is an uncommon skin neoplasm of the elderly population. The majority of patients with MCC present with localized disease at diagnosis and few patients have regional lymph node (LN) involvement and distant metastases. […] Although it has been previously reported in various anatomical sites, LN metastatic MCC in the absence of a primary site is extremely rare and for this reason there is no standard approach to its management. Currently, there is no standard approach to the management of MCC in the absence of a primary site. […] A chest, abdomen and pelvis CT scan usually confirms LN involvement and reveals the extent of disease. Recently the role of PET/CT has been upgraded in depicting the sites of LN disease in MCC due to its high reported specificity and sensitivity, 98% and 90% respectively.

• #1 Cancer of Unknown Primary Treatment (PDQ®) – NCI

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

  Most patients with newly diagnosed cancer of unknown primary (CUP) are considered to have an unfavorable prognosis. […] Treatment options for newly diagnosed unfavorable CUP include site-directed therapy based on molecular tissue of origin/molecular targeted therapy, immunological therapy, and chemotherapy. […] The use of follow-up studies including computed tomography or magnetic resonance imaging, is extrapolated from paradigms of other related malignancies with known primary sites. No prospective trials evaluating clinical surveillance have been conducted for patients with cancer of unknown primary.

• #1 Extent of diagnostic inquiry among a population-based cohort of patients with cancer of unknown primary

  https://www.oatext.com/extent-of-diagnostic-inquiry-among-a-population-based-cohort-of-patients-with-cancer-of-unknown-primary.php

  Only 35% of elderly CUP patients identified in the cancer registry received a complete diagnostic evaluation. […] For accurate assessment of the CUP burden and disparities in utilization of diagnostic care, we recommend that the SEER definition of CUP include the extent of diagnostic inquiry. […] CUP presents challenges to cancer surveillance because CUP is a diagnosis of exclusion. […] Cancer registries, a major source of cancer research and surveillance, do not currently document the extent of the diagnostic evaluation. […] The crude analysis showed that 35.3% of patients received a complete diagnostic evaluation within three months of diagnosis. […] The adjusted probability of treatment was highest among patients receiving molecular tests, 57.2%, 95%CI (48.2,66.2), immunohistochemistry, 46.8%, 95%CI (44.6,49.0), and complete diagnostic evaluation, 46.7%, 95%CI (44.4,49.1). […] The potential misclassification of CUP in cancer registries can influence population based assessments of clinical, public health, and health services interventions.

• #1 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. […] Seven thousand five hundred ninety nine patients were diagnosed with CUP over the study period, 54.4% female, 67.4% aged 70 years, 36.7% from the most deprived socio-economic quintile. […] 71% of all diagnoses were made during a hospital admission, among which 88.6% were emergency presentations and the majority (56.3%) were admitted to general medicine. […] Median length of stay was 15 days and median survival after admission 33 days. […] To ensure that patients with CUP are quickly identified and directed to optimal care, increased surveillance and rapid referral pathways will be required.

• #1 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

  They reported that diagnoses were 20% higher among females, nearly 40% were over 80 years old and 57% were diagnosed after an emergency hospital admission. […] In a large population-based series of patients with Cancers of Unknown Primary, we found that the majority were diagnosed during a hospital admission, half of whom died during that admission. […] Survival after admission was short, being a median of 33 days and poorer in emergency compared to elective admissions. […] Given the poor outcomes of patients admitted to hospital with CUP, is there scope for better primary and secondary prevention? […] Cancers of Unknown Primary have poor outcomes and the opportunities to better identify and manage such patients may be limited because of patients short survival after hospital admission.

• #1 Cancer of Unknown Primary (CUP) Treatment (PDQ®): Treatment – Health Professional Information [NCI] | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.cancer-of-unknown-primary-cup-treatment-pdq%C2%AE-treatment-health-professional-information-nci.ncicdr0000062936

  The U.S. Food and Drug Administration (FDA) has approved some novel targeted therapies when a molecular target is identified in a cancer, regardless of primary site (including when no primary site is evident with metastases). […] Most patients with newly diagnosed cancer of unknown primary (CUP) are considered to have an unfavorable prognosis. […] Treatment options for newly diagnosed unfavorable CUP include site-directed therapy based on molecular tissue of origin/molecular targeted therapy, immunological therapy, and chemotherapy. […] The use of follow-up studies including computed tomography or magnetic resonance imaging is extrapolated from paradigms of other related malignancies with known primary sites. No prospective trials evaluating clinical surveillance have been conducted for patients with cancer of unknown primary.

• #1 Frontiers | Does Cancer of Unknown Primary (CUP) Truly Exist as a Distinct Cancer Entity?

  https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2019.00402/full

  The diagnosis of CUP remains valid as long as no primary tumor in the respective organ is detectable. […] In most cases, the CUP diagnosis is correct, because metastatic spread has been histologically confirmed and a primary tumor has remained elusive in spite of a thorough work-up according to the ESMO guidelines. […] Current studies are investigating response to treatment tailored to the primary predicted by classifier assays as proof-of-principle trials. […] Data from clinical trials in CUP are scarce, with only few phase II studies and a single phase III study. […] There is broad consensus that the ESMO guidelines should be applied for clinical trials.

• #1

  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. […] The overall prognosis of CUP patients is generally very poor with a median survival of 4-12 months. It has been reported that around 50% of patients alive at 1 year and 10% at 5 years from diagnosis. […] 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. […] The overall prognosis of these patients was generally very poor with a median survival of 6-12 months in our set of patients. […] In conclusion, 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. Larger studies with other therapeutic and novel agents are warranted to improve the treatment outcomes.

• #1 Descriptive epidemiology of cancer of unknown primary site in Scotland, 1961–2010

  https://eprints.gla.ac.uk/94730/

  Cancers of unknown primary site (CUP) pose problems for diagnosis, treatment, and accurate prediction of prognosis. However, there are limited published data describing the epidemiology of this disease entity. Our aim was to describe the epidemiology of CUP in Scotland. Between 1961 and 2010, there were 50,941 registrations of CUP, representing 3.9% of all registrations of invasive cancers. Age-standardised rates increased to a peak in the early to mid-1990s, followed by a steeper decrease in rates. During 2001-2010, age-standardised rates of CUP were higher in the most compared with the least deprived fifth of the population. Observed survival was marginally higher in patients diagnosed during 2001-2010 (median 5.6 weeks) compared with those diagnosed in the previous two decades. During the most recent decade, survival decreased with age at diagnosis, and was higher in patients with squamous cell carcinoma and with lymph node metastases. Patterns of CUP in Scotland are largely consistent with those reported from the few other countries that have published data. However, in comparing studies, it is important to note that there is heterogeneity in terms of definition of CUP, as well as calendar period of diagnosis or death. Variation in the definition of CUP between different epidemiological studies suggests that there would be merit in seeking international agreement on guidelines for the registration of CUP as well as a standard grouping of diagnostic codes for analysis.

• #2 Frontiers | Does Cancer of Unknown Primary (CUP) Truly Exist as a Distinct Cancer Entity?

  https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2019.00402/full

  Cancer of unknown primary (CUP) designates an enigmatic cancer entity with histologic confirmation of malignancy from a metastasis but no identifiable primary tumor in spite of a thorough diagnostic work-up. […] CUP cases share an aggressive clinical course, atypical metastasis pattern, rapid progression of metastases, a generally poor response to chemotherapy and dismal outcome as distinct clinical features. […] The diligent diagnosis of CUP is warranted for clinical trials, making the eligibility process particularly laborious. […] In conclusion, we deem CUP a distinct cancer entity and the diagnosis accurate in most patient cases. […] CUP is diagnosed in malignancies, where metastases have been histologically confirmed, but where no primary site can be identified in spite of a comprehensive diagnostic work-up.

• #2 Key Statistics for Cancers of Unknown Primary | American Cancer Society

  https://www.cancer.org/cancer/types/cancer-unknown-primary/about/key-statistics.html

  The exact number of cancers of unknown primary (CUP) diagnosed each year is unknown, because some cancers start out being diagnosed as unknown primary, but the primary site is found later. Still, the American Cancer Society estimates that about 37,370 cases of cancer of unknown primary will be diagnosed in 2025 in the United States. This number represents about 2% of all cancers. […] As more sophisticated lab tests become available to determine where a cancer started, the number of cancers of unknown primary may go down.

• #2

  https://hal.science/hal-03485854v1/document

  The currently declining incidence of cancer of unknown primary

• #2 Carcinoma of Unknown Primary Site

  https://www.csh.org.tw/Dr.TCJ/Educartion/f/web/Carcinoma%20of%20Unknown%20Primary%20Site/index.htm

  Carcinoma of unknown primary site is a common clinical syndrome, accounting for approximately 3% of all oncologic diagnoses. […] Unknown primary cancer occurs with approximately equal frequency in men and women, and has the same prognosis in the two genders. […] As with most epithelial cancers, the incidence of unknown primary cancer increases with advancing age, although a wide age range exists. […] Autopsy series performed prior to the availability of CT resulted in the identification of a primary site in 70%-80% of patients. […] With improved radiologic diagnosis, the spectrum of unknown primary cancer has probably changed. Limited recent autopsy data suggest a lower percentage of primary sites identified, particularly in patients with poorly differentiated histology. […] After a biopsy has established metastatic carcinoma, a relatively limited clinical evaluation is indicated to search for a primary site.

• #2 CUP Syndrome – Cancer of Unknown Primary — Onkopedia

  https://www.onkopedia.com/en/onkopedia/guidelines/cup-syndrome-2013-cancer-of-unknown-primary

  The incidence of CUP has been decreasing since the turn of the century in Western industrialized countries and is 4-15/100,000 inhabitants/year, corresponding to 1-3% of all cancer cases. […] According to RKI data, about three quarters of patients affected die within one year after diagnosis, and around 10% are alive after 5 years. […] Overall, mortality in CUP (unchanged in 2020 as compared to previous years) takes the 6th place (4.6%) of all cancer deaths in Germany. […] The peak age of onset is 53 to 62 years, and men are affected slightly more often than women (around 1.1:0.9). […] The ESMO guideline recommends the use of PET-CT additionally in singular metastases or oligometastatic disease, if there is a prospect of local ablative therapy in curative intention with surgery and / or radio(chemo)therapy. […] Evidence-based guidelines for follow-up in CUP syndrome are not available.

• #2 Cancer of unknown primary incidence statistics | Cancer Research UK

  https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cancer-of-unknown-primary/incidence

  Cancer of unknown primary is the 15th most common cancer in the UK, accounting for 2% of all new cancer cases (2017-2019). […] In females in the UK, cancer of unknown primary is the 11th most common cancer (2% of all new female cancer cases). In males in the UK, it is the 15th most common cancer (2% of all new male cancer cases). […] Cancer of unknown primary incidence rates (European age-standardised (AS) rate) for persons are significantly higher than the UK average in Scotland and Wales and significantly lower than the UK average in England and Northern Ireland. […] For cancer of unknown primary, there are few established risk factors therefore differences between countries largely reflect differences in diagnosis and data recording. […] In the UK in 2017-2019, on average each year almost 6 in 10 new cases (58%) were in people aged 75 and over.

• #2 Cancer of unknown primary site

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

  CUP occurs at higher rates in men than in women; in people living in remote areas, compared with those in major cities; in people living in areas of lower socioeconomic status, compared with higher; and in Aboriginal and Torres Strait Islander peoples, compared with non-Indigenous Australians. […] Evidence from a single prospective cohort study suggests that heavy smoking is associated with an increased risk of CUP (about 4-fold), and high alcohol consumption and wide waist circumference may also increase risk. […] The CUP subtypes and observed pattern of diagnostic investigation in elderly Australians suggest under-investigation in some patients with CUP. […] Published CUP clinical practice guidelines recommend diagnostic pathways that vary depending on the extent of metastasis, the involved site(s), the suspected origin and the overall health of the patient.

• #2 Cancer of unknown primary: a population-based analysis of temporal change and socioeconomic disparities | British Journal of Cancer

  https://www.nature.com/articles/bjc2013386

  Cancer of unknown primary (CUP) is the fourth most common cause of cancer death. […] The percentage of all cancers diagnosed as CUP has decreased over time comprising 2% of cancers since 2007. […] A higher proportion of CUP was diagnosed in the elderly, females, blacks and residents of less affluent or less educated counties. […] The percentage of cancers diagnosed as CUP is decreasing but prognosis remains poor, particularly in non-SCC CUP. However, significant socioeconomic disparities exist in diagnosis and survival, suggesting inequalities in access to diagnostic investigations and treatment. […] The proportion of cancer cases diagnosed as CUP decreased over time within all subgroups analysed. However, disparities between different socioeconomic groups are evident. […] Since the mid-1990s, the proportion of CUP cases was lower in areas of higher education and affluence, compared with less educated and poorer areas.

• #2 Unknown Primary Carcinomas: Diagnosis and Management

  https://www.cancernetwork.com/view/unknown-primary-carcinomas-diagnosis-and-management

  Unknown primary carcinomas are a significant health problem, constituting 3% to 10% of all tumors diagnosed in the United States each year. […] Unknown primary carcinomas affect males and females equally. The median age at presentation is 56 to 60 years, and 10% of patients with an unknown primary tumor have a history of an antecedent cancer. […] About 60% of the patients who present with an unknown primary carcinoma will be diagnosed with metastatic adenocarcinoma. An additional 30% of patients will have undifferentiated or poorly differentiated carcinomas. […] The poor prognosis of these malignancies reflects the overall poor prognosis of unknown primary tumors as a group. […] The treatment of malignancy is traditionally based on the identification of the origin of the tumor, and treatment is chosen and initiated based upon the natural history and the most specific therapies available for a certain type of tumor.

• #2 Risk factors for cancer of unknown primary: a literature review | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-023-10794-6

  Cancer of Unknown Primary (CUP) is metastatic cancer with an unidentifiable primary tumour origin during life. It remains difficult to study the occurrence and aetiology of CUP. Hitherto, it is unclear whether risk factors are associated with CUP, yet identifying these factors could reveal whether CUP is a specific entity or a cluster of metastasised cancers from various primary tumour origins. Epidemiological studies on possible CUP risk factors were systematically searched in PubMed and Web of Science on February 1st, 2022. Studies, published before 2022, were included if they were observational human-based, provided relative risk estimates, and investigated possible CUP risk factors. A total of 5 casecontrol and 14 cohort studies were included. There appears to be an increased risk for smoking in relation to CUP. However, limited suggestive evidence was found to link alcohol consumption, diabetes mellitus, and family history of cancer as increased risks for CUP. No conclusive associations could be made for anthropometry, food intake (animal or plant-based), immunity disorders, lifestyle (overall), physical activity, or socioeconomic status and CUP risk. No other CUP risk factors have been studied. This review highlights smoking, alcohol consumption, diabetes mellitus and family history of cancer as CUP risk factors. Yet, there remains insufficient epidemiological evidence to conclude that CUP has its own specific risk factor profile.

• #2 Cancer of Unknown Primary | CancerIndex

  http://www.cancerindex.org/Unknown_Primary

  This study contributes to a continuing discussion of how to improve the accuracy of diagnosis and quality of treatment of HNCUP patients. […] Cancer of unknown primary (CUP) accounts for 3% to 5% of all cancers and is associated with poor prognosis. […] Relatives of patients with CUP are at increased risk of CUP and several other malignant neoplasms, including lung, pancreatic, and colon cancer.

• #2 Cancer of unknown primary incidence statistics | Cancer Research UK

  https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cancer-of-unknown-primary/incidence

  For cancer of unknown primary, like most cancer types, incidence increases with age. This largely reflects cell DNA damage accumulating over time. Damage can result from biological processes or from exposure to risk factors. […] Cancer of unknown primary European age-standardised (AS) incidence rates for females and males combined decreased by 60% in the UK between 1993-1995 and 2017-2019. […] The decrease was larger in males than in females. […] Cancer of unknown primary incidence rates have decreased overall in all broad age groups in females and males combined in the UK since the early 1990s. […] CUP incidence trends reflect improvements in data collection and diagnostic capabilities which mean identification of primary site is possible for more cancer cases, hence fewer cases are registered as CUP.

• #2 Real-world data analysis of patients with cancer of unknown primary | Scientific Reports

  https://www.nature.com/articles/s41598-021-02543-1

  Cancer of unknown primary (CUP) is a heterogeneous malignancy in which the primary site of the tumor cannot be identified through standard work-up. The survival outcome of CUP is generally poor, and there is no consensus for treatment. […] Most patients with CUP have been included in unfavorable subsets and showed poor prognosis, with a median overall survival (OS) of 6 months. […] Despite recent advances in diagnostic techniques and treatment strategies, the characteristics of CUP and treatment patterns in real-world settings are not well-known. […] The clinical utility of tailored therapy is also yet to be established as there are few studies on how novel targeted therapies are being applied in clinical practice. […] The median OS of the study patients as a whole was 8.3 months. […] When divided according to the ECOG PS, those with ECOG PS 0 or 1 had a median OS duration of 13.3 months and those with ECOG PS greater than 1 had a median OS duration of 3.9 months.

• #2 Cancer of Unknown Primary (CUP) Treatment (PDQ®): Treatment – Health Professional Information [NCI] | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.cancer-of-unknown-primary-cup-treatment-pdq%C2%AE-treatment-health-professional-information-nci.ncicdr0000062936

  A cancer of unknown primary (CUP) is defined as a biopsy-confirmed malignancy with no established primary site after pathological evaluation and radiographic studies. With the advent of comprehensive genomic profiling and positron emission tomography-computed tomography scanning, less than 1% of new cancer diagnoses are designated as CUP. […] The prognosis for patients with CUP is poor. Approximately 30% of patients are alive at 1 year. CUP is represented by a heterogeneous group of diseases, all of which have presented with metastasis as the primary manifestation. […] Survival is worse for patients with any of the following characteristics: adenocarcinoma or undifferentiated carcinoma histology, extranodal presentation, older age, hepatic or adrenal involvement, poor performance status, and elevated serum lactate dehydrogenase (LDH).

• #2 CUP Syndrome (Cancer of Unknown Primary) | Medically Roche

  https://medically.roche.com/global/en/microsites/about-cup-syndrome/cup-syndrome.html

  CUP syndrome accounts for approximately 35% of all cancer cases. […] Only 15-20% of patients with CUP have a favourable prognosis based on their clinicopathological classification. These patients have chemosensitive and potentially curable tumours and can achieve long-term disease control with a multidisciplinary approach. […] The majority of CUP patients (80-85%) have a poor prognosis, meaning that treatment response is poor and median overall survival is generally less than one year. […] The survival rates for patients with poor prognosis are low: 1 year: 38%, 5 years: 10%, 10 years: 8%. […] Treatment should be tailored to the individual patient according to the clinicopathological characteristics and its subsequent prognostic classification. The 15-20% of CUP patients with a favourable prognosis should be treated similarly to patients with metastases from equivalent known primary tumours.

• #2 Cancer of unknown primary: a population-based analysis of temporal change and socioeconomic disparities | British Journal of Cancer

  https://www.nature.com/articles/bjc2013386

  The median survival of all CUP carcinoma patients was 3 months (range 0-30 months), with no improvement in the median survival over time in the overall cohort. […] The overall prognosis for patients diagnosed with CUP remains poor, with an overall median survival of 3 months. […] The lack of improvement in the survival over time in patients with non-squamous CUP may actually reflect a type of selection bias. […] The disparities demonstrated in this study highlight the need for policy interventions to ensure that the most vulnerable and disadvantaged patients with CUP have access to all available advances in diagnostic and therapeutic modalities.

• #2 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

  The incidence of CUP has risen and then fallen over the past 50 years, possibly driven initially by greater diagnostic sensitivity detecting more metastatic disease and then latterly by better identification of the primary site reducing the number of unknown primaries. […] Worldwide, CUP are the 6th to 8th most common cancers, accounting for 2.35% of all cancer diagnoses but the 3rd to 4th most common cause of death from cancer. […] Survival is poor, with a median of 5.6 weeks. […] Survival is more favourable among patients whose disease mimics clinicopathological features of known metastatic cancers and responds to appropriate treatment (median survival 24 months) but the majority of patients (80-85%) respond poorly to treatment. […] The National Cancer Intelligence Network reported on routes to diagnosis of CUP between 2006 and 2010.

• #2 Real-world data analysis of patients with cancer of unknown primary | Scientific Reports

  https://www.nature.com/articles/s41598-021-02543-1

  The OS according to disease extent is shown in Fig. 3b. The median OS duration was 34.6 months for localized disease and 6 months for disseminated disease, respectively. […] Although the overall survival outcome of CUP was poor, subgroups of patients who had localized disease treated with CCRT demonstrated favorable outcomes (median OS, 51.7 months). […] In our study, we used the OncoKB data for classification, and 10 (43.5%) out of 23 patients showed level 1, 2, or 3 alterations. […] In a study conducted in South Korea, 17 among 21 patients who underwent NGS showed possible clinical genomic alterations and only one received targeted therapy. […] The CUPISCO study (NCT03498521) is currently ongoing, which is a randomized trial comparing individualized targeted treatment or immunotherapy with standard platinum-based chemotherapy in patients with CUP.

• #2 Cancer of Unknown Primary Treatment (PDQ®) – NCI

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

  A cancer of unknown primary (CUP) is defined as a biopsy-confirmed malignancy with no established primary site after pathological evaluation and radiographic studies. With the advent of comprehensive genomic profiling and positron emission tomography-computed tomography scanning, less than 1% of new cancer diagnoses are designated as CUP. […] The prognosis for patients with CUP is poor. Approximately 30% of patients are alive at 1 year. CUP is represented by a heterogeneous group of diseases, all of which have presented with metastasis as the primary manifestation. […] Survival is worse for patients with any of the following characteristics: adenocarcinoma or undifferentiated carcinoma histology, extranodal presentation, older age, hepatic or adrenal involvement, poor performance status, elevated serum lactate dehydrogenase (LDH).

• #2 Cancer of Unknown Primary (CUP) Treatment (PDQ®): Treatment – Health Professional Information [NCI] | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.cancer-of-unknown-primary-cup-treatment-pdq%C2%AE-treatment-health-professional-information-nci.ncicdr0000062936

  A review of five case control studies and 14 cohort studies found a clear increased risk of CUP with smoking. […] Conceptually, CUP is a type of tumor that tends to metastasize early, unlike more common cases, in which the primary tumor is apparent, with or without metastasis. […] The pathologist has a central role in the evaluation of CUP. A thorough evaluation of an adequate specimen for histological, immunohistochemical, molecular diagnostics, next-generation sequencing (NGS), and, when appropriate, electron microscopic evaluations provides the most important clues in the diagnosis of CUP. […] Clinical, pathological, and molecular genetic tests have two goals. The first is to identify tumors that are responsive to available therapies. The second is to identify novel targeted therapies that might be applicable to the particular genetic profile.

• #2 Cancer of Unknown Primary (CUP) Treatment (PDQ®): Treatment – Health Professional Information [NCI] | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.cancer-of-unknown-primary-cup-treatment-pdq%C2%AE-treatment-health-professional-information-nci.ncicdr0000062936

  The U.S. Food and Drug Administration (FDA) has approved some novel targeted therapies when a molecular target is identified in a cancer, regardless of primary site (including when no primary site is evident with metastases). […] Most patients with newly diagnosed cancer of unknown primary (CUP) are considered to have an unfavorable prognosis. […] Treatment options for newly diagnosed unfavorable CUP include site-directed therapy based on molecular tissue of origin/molecular targeted therapy, immunological therapy, and chemotherapy. […] The use of follow-up studies including computed tomography or magnetic resonance imaging is extrapolated from paradigms of other related malignancies with known primary sites. No prospective trials evaluating clinical surveillance have been conducted for patients with cancer of unknown primary.

• #2 Extent of diagnostic inquiry among a population-based cohort of patients with cancer of unknown primary

  https://www.oatext.com/extent-of-diagnostic-inquiry-among-a-population-based-cohort-of-patients-with-cancer-of-unknown-primary.php

  Only 35% of elderly CUP patients identified in the cancer registry received a complete diagnostic evaluation. […] For accurate assessment of the CUP burden and disparities in utilization of diagnostic care, we recommend that the SEER definition of CUP include the extent of diagnostic inquiry. […] CUP presents challenges to cancer surveillance because CUP is a diagnosis of exclusion. […] Cancer registries, a major source of cancer research and surveillance, do not currently document the extent of the diagnostic evaluation. […] The crude analysis showed that 35.3% of patients received a complete diagnostic evaluation within three months of diagnosis. […] The adjusted probability of treatment was highest among patients receiving molecular tests, 57.2%, 95%CI (48.2,66.2), immunohistochemistry, 46.8%, 95%CI (44.6,49.0), and complete diagnostic evaluation, 46.7%, 95%CI (44.4,49.1). […] The potential misclassification of CUP in cancer registries can influence population based assessments of clinical, public health, and health services interventions.

• #2 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. […] Seven thousand five hundred ninety nine patients were diagnosed with CUP over the study period, 54.4% female, 67.4% aged 70 years, 36.7% from the most deprived socio-economic quintile. […] 71% of all diagnoses were made during a hospital admission, among which 88.6% were emergency presentations and the majority (56.3%) were admitted to general medicine. […] Median length of stay was 15 days and median survival after admission 33 days. […] To ensure that patients with CUP are quickly identified and directed to optimal care, increased surveillance and rapid referral pathways will be required.

• #3 Carcinoma of Unknown Primary Site

  https://www.csh.org.tw/Dr.TCJ/Educartion/f/web/Carcinoma%20of%20Unknown%20Primary%20Site/index.htm

  Carcinoma of unknown primary site is a common clinical syndrome, accounting for approximately 3% of all oncologic diagnoses. […] Unknown primary cancer occurs with approximately equal frequency in men and women, and has the same prognosis in the two genders. […] As with most epithelial cancers, the incidence of unknown primary cancer increases with advancing age, although a wide age range exists. […] Autopsy series performed prior to the availability of CT resulted in the identification of a primary site in 70%-80% of patients. […] With improved radiologic diagnosis, the spectrum of unknown primary cancer has probably changed. Limited recent autopsy data suggest a lower percentage of primary sites identified, particularly in patients with poorly differentiated histology. […] After a biopsy has established metastatic carcinoma, a relatively limited clinical evaluation is indicated to search for a primary site.

• #3 Extent of diagnostic inquiry among a population-based cohort of patients with cancer of unknown primary

  https://www.oatext.com/extent-of-diagnostic-inquiry-among-a-population-based-cohort-of-patients-with-cancer-of-unknown-primary.php

  Only 35% of elderly CUP patients identified in the cancer registry received a complete diagnostic evaluation. […] For accurate assessment of the CUP burden and disparities in utilization of diagnostic care, we recommend that the SEER definition of CUP include the extent of diagnostic inquiry. […] CUP presents challenges to cancer surveillance because CUP is a diagnosis of exclusion. […] Cancer registries, a major source of cancer research and surveillance, do not currently document the extent of the diagnostic evaluation. […] The crude analysis showed that 35.3% of patients received a complete diagnostic evaluation within three months of diagnosis. […] The adjusted probability of treatment was highest among patients receiving molecular tests, 57.2%, 95%CI (48.2,66.2), immunohistochemistry, 46.8%, 95%CI (44.6,49.0), and complete diagnostic evaluation, 46.7%, 95%CI (44.4,49.1). […] The potential misclassification of CUP in cancer registries can influence population based assessments of clinical, public health, and health services interventions.

• #3 Frontiers | Does Cancer of Unknown Primary (CUP) Truly Exist as a Distinct Cancer Entity?

  https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2019.00402/full

  The diagnosis of CUP remains valid as long as no primary tumor in the respective organ is detectable. […] In most cases, the CUP diagnosis is correct, because metastatic spread has been histologically confirmed and a primary tumor has remained elusive in spite of a thorough work-up according to the ESMO guidelines. […] Current studies are investigating response to treatment tailored to the primary predicted by classifier assays as proof-of-principle trials. […] Data from clinical trials in CUP are scarce, with only few phase II studies and a single phase III study. […] There is broad consensus that the ESMO guidelines should be applied for clinical trials.

• #4 Extent of diagnostic inquiry among a population-based cohort of patients with cancer of unknown primary

  https://www.oatext.com/extent-of-diagnostic-inquiry-among-a-population-based-cohort-of-patients-with-cancer-of-unknown-primary.php

  Only 35% of elderly CUP patients identified in the cancer registry received a complete diagnostic evaluation. […] For accurate assessment of the CUP burden and disparities in utilization of diagnostic care, we recommend that the SEER definition of CUP include the extent of diagnostic inquiry. […] CUP presents challenges to cancer surveillance because CUP is a diagnosis of exclusion. […] Cancer registries, a major source of cancer research and surveillance, do not currently document the extent of the diagnostic evaluation. […] The crude analysis showed that 35.3% of patients received a complete diagnostic evaluation within three months of diagnosis. […] The adjusted probability of treatment was highest among patients receiving molecular tests, 57.2%, 95%CI (48.2,66.2), immunohistochemistry, 46.8%, 95%CI (44.6,49.0), and complete diagnostic evaluation, 46.7%, 95%CI (44.4,49.1). […] The potential misclassification of CUP in cancer registries can influence population based assessments of clinical, public health, and health services interventions.

• #5 Extent of diagnostic inquiry among a population-based cohort of patients with cancer of unknown primary

  https://www.oatext.com/extent-of-diagnostic-inquiry-among-a-population-based-cohort-of-patients-with-cancer-of-unknown-primary.php

  Only 35% of elderly CUP patients identified in the cancer registry received a complete diagnostic evaluation. […] For accurate assessment of the CUP burden and disparities in utilization of diagnostic care, we recommend that the SEER definition of CUP include the extent of diagnostic inquiry. […] CUP presents challenges to cancer surveillance because CUP is a diagnosis of exclusion. […] Cancer registries, a major source of cancer research and surveillance, do not currently document the extent of the diagnostic evaluation. […] The crude analysis showed that 35.3% of patients received a complete diagnostic evaluation within three months of diagnosis. […] The adjusted probability of treatment was highest among patients receiving molecular tests, 57.2%, 95%CI (48.2,66.2), immunohistochemistry, 46.8%, 95%CI (44.6,49.0), and complete diagnostic evaluation, 46.7%, 95%CI (44.4,49.1). […] The potential misclassification of CUP in cancer registries can influence population based assessments of clinical, public health, and health services interventions.

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