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Cancer of unknown primary (CUP) is a disease manifested by metastatic tumors, while the primary focus cannot be revealed either based on the medical history of the patient or according to clinical examination data.
Sometimes the localization of the primary malignant focus is unknown. In such cases, it is called cancer of unknown primary (CUP).
Since this type of cancer metastasizes at the first stages, by the time the patient seeks medical help, the metastatic process usually spreads beyond one organ.
Cancer of unknown primary includes cases of oncological disease manifested by metastatic tumors, while the primary tumor is not revealed. The primary focus can be found with the help of additional examinations, and then the diagnosis is changed, and the treatment tactic is adjusted accordingly.
The primary localization of a malignant tumor is one of the main clinical criteria in establishing the treatment tactic. Cancer of unknown primary (CUP) is difficult to diagnose, but it is still possible.
Nevertheless, even if the origin of cancer is unknown, treatment still can be successful. According to statistics, the mortality rate of patients with cancer of unknown primary has decreased by 42% over the last ten years.
And even when it’s unknown where cancer has originated, professionals do their best to identify the tumor origin, which will help them choose the best treatment option.
Following cancer types can be diagnosed without identification of a primary localization:
Depending on the metastases spreading, patients are divided into few groups:
Symptoms of cancer of unknown primary (CUP) are nonspecific and depend on the localization of metastases and the spreading of the tumor process. However, depending on the localization of metastases, symptoms of cancer of unknown primary may vary.
For example, if metastases of primary cancer unknown (CUP) are found in the lungs, symptoms such as cough and shortness of breath are noticed. With metastases in the bones, pain in the bones or fracture of bones can develop. With metastases in the liver, pain in the abdomen, nausea, jaundice, or ascites may develop. With metastases in the lymph nodes, swollen lymph nodes are noticed.
General symptoms of cancer of unknown primary include:
Clinical examination of patients with cancer of unknown primary is complicated. The diagnostic algorithm in patients with metastatic sites without an identified primary tumor involves several stages, including:
A preliminary assessment is carried out based on a physical examination of the patient. It should be noted that the general health condition of the patient is an important factor in the choice of diagnostic tactics. Obviously, it makes no sense for a patient in a serious health condition to conduct a full examination. Even if it is possible to identify the primary tumor, the patient won’t undergo intense treatments. In this situation, a diagnostic program that includes only the first three stages is more suitable. In especially severe cases, the administration of symptomatic therapy should be discussed without examination.
After clinical analysis of chest X-ray data, ultrasound scan of the abdominal cavity, retroperitoneal region and small pelvis, and computed tomography, the localization of metastases is estimated. The use of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET, PET-CT) allows professionals to identify additional metastatic sites, specifying the spreading of metastases, and determining the localization of the primary focus.
An important stage of the clinical examination is a histological study of the tissue harvested during puncture or biopsy. Histological examination is significant, it should be performed as early as possible. The data obtained makes it possible to confirm the malignancy of the process, to determine the tissue type from which the tumor has developed, to assess the degree of malignancy of cancer cells, and sometimes to assume the localization of the primary tumor, which greatly facilitates the search for the primary focus and reduces the number of diagnostic procedures.
Since the primary focus remains unknown, any treatment carried out is hardly radical. Therefore, the choice of treatment tactic in people with cancer of unknown primary (CUP) is an issue that should be managed on an individual basis in each specific case. The therapeutic tactics are determined, first of all, taking into account the general health condition of the patient, the localization of metastases, the spreading of the tumor process, the type of the metastatic tumor, and the assumed localization of the primary focus.
Recently, researches have been carried out to develop therapeutic tactics that are not based on the localization of cancer of unknown primary, but are based on the biological characteristics of the tumor. This will make it possible to make the treatment more individualized and use targeted therapy more often. It has been proven that the average life expectancy of people who received targeted treatment is significantly higher than that of those whose treatments were limited to symptomatic therapy. The best five-year survival rates were observed in people with isolated metastases in the inguinal, axillary, and cervical lymph nodes who received targeted treatments.
The surgical method of treatment in patients with cancer of unknown primary is not radical. It can be used in case of involvement of the lymph nodes that can be removed or in isolated organ damage. Lymphadenectomy (lymph node removal) or removal of metastases with organ resection is possible. Also, surgical intervention may be performed with a symptom managing purpose.
Radiation therapy can be indicated for patients with isolated metastatic areas in the lymph nodes or organs with potential sensitivity to radiation. It is also possible to use radiation therapy as the symptomatic treatment option.
Since cancer of unknown primary (CUP) suggests a disseminated process or presence of distant metastatic, systemic drug therapy is considered to be the main method of treatment.
Treatment is personalized and based on all available clinical and histological data. The cellular characteristics of the tumor and its potential susceptibility to certain drugs are of decisive importance. If certain mutations are identified in the tumor, targeted therapy can be used. In cases of distant metastases, the combination of chemotherapy with surgical and radiation methods can lead to the achievement of significantly better results.
The prognosis in patients with metastases in cancer of unknown primary is not always unfavorable.
The survival rate is higher in patients with isolated metastases compared to the group of patients with multiple metastases in the lymph nodes and concomitant damage of the other organs.
The best five-year survival rates were observed in patients with isolated metastases in the inguinal, axillary, and cervical lymph nodes who received specialized treatment. Women with metastases in the axillary lymph nodes and the pronounced expression of estrogen and progesterone receptors have the most favorable prognosis.
Depending on the histological type of the tumor, the best five-year survival rates are observed in the group of patients with metastases of squamous cell carcinoma. An unfavorable prognostic factor is the localization of metastases in the brain and liver.
Patients with cancer of unknown primary should undergo clinical and laboratory or instrumental follow-up every 3-6 months. With monitoring the dynamics of the disease, it is possible to identify the primary tumor, which will allow more targeted treatment.
The following hospitals show the best success rates in the treatment of cancer of unknown primary (CUP):
You can find more information about the hospitals and the services they provide on the Booking Health website.
The prices in hospitals that are listed on Booking Health are relatively low. However, the cost of treatment may differ depending on the hospital, the peculiarities of the disease in each case, and the complexity of its treatment.
For example, the cost of diagnostics of cancer of unknown primary in Germany starts at 9,227 EUR, while the cost of diagnostics of cancer of unknown primary in Turkey starts at 5,306 EUR.
Besides the actual cost of treatment, you might want to consider the prices for possible additional procedures and follow-up care. Therefore, the ultimate cost of treatment may differ from the initial price.
To find out more information on the overall cost of treatment, you may leave the request on the Booking Health website.
Medical tourism company Booking Health will help you arrange treatment of cancer of unknown primary, so you will not need to take care about cancer treatment organization.
Booking Health offers the following services:
And this is not even a full list. With Booking Health, you receive the treatment in the best hospitals in the world, where it is carried out by professionals in the field of oncology, internal medicine, etc.
If you have any questions, you may leave a request on the Booking Health website, and our manager will assist you.
Authors: Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko
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