Cancer of unknown primary (CUP) is the formal diagnosis given when cancer has spread through the body but it is not clear whereabouts in the body the cancer began.

It affects between 3 and 5 in every 100 people diagnosed with cancer.

About cancer of unknown primary (CUP)

Sometimes people only find out they have cancer when it has already spread from the place it began (the primary cancer) to one or more other parts of the body. 

Your clinical team will try to identify whereabouts in the body the cancer started (the primary cancer) because this tells us what treatments are likely to work best. 

For example, if you have breast cancer that has spread to your lung then treatments for breast cancer will work better than treatments aimed at lung cancer. This is because the cancer in the lung is caused by breast cancer cells that have spread there.

It is not always obvious whereabouts the cancer began. You may hear this described as malignancy of unknown origin or as cancer of unknown primary:

  • Malignancy of unknown origin – this is a term used when cancer is diagnosed in an emergency setting and it is not obvious where in the body it began without further tests. Your clinical team will arrange tests to try and identify where the cancer began
  • Cancer of unknown primary – this is the formal diagnosis given when it is not possible to tell where in the body it began, even after the usual tests. You may also be diagnosed with it if you are not well enough to have tests to try and find the primary cancer

Cancer of unknown primary (CUP) is more common in older people but younger people can also get it. 

There are several reasons why it may not be possible to tell where the cancer began (primary cancer):

  • The secondary cancer or cancers have grown and spread very quickly, but the primary is still too small to be picked up on scans
  • The cancer has been growing in more than one area of the body for some time, making it difficult to see where it started
  • The primary cancer might have disappeared, even though it has spread to other parts of the body

There are no specific symptoms of cancer of unknown primary (CUP). It is usually found when people just feel very unwell and do not get better. 

People with advanced cancer may have some of these symptoms: 

  • Unexplained weight loss 
  • Loss of appetite
  • Feeling sick (nausea) or being sick (vomiting)
  • Feeling extremely tired all of the time 
  • Looking paler than usual 
  • Unexplained pain that does not go away
  • A cough that doesn’t go away 
  • Breathlessness 
  • Yellowing of the skin and eyes (jaundice) 
  • Swelling of your tummy (ascites) 
  • Your lymph glands (glands in your neck, groin or under arms) may be swollen and feel hard or cause pain if they’re pressing on tissue or nerves nearby
  • Headache, confusion and loss of balance 
  • Bowel changes 

It is important to see a health professional if you have symptoms or unexplained changes in your body that are persistent – i.e. they last more than a couple of weeks. 

At The Clatterbridge Cancer Centre, we provide specialist non-surgical treatment for cancer. We also work closely with teams in other hospitals to plan and coordinate your care every step of the way. 

When you are diagnosed, your care will be discussed at a multidisciplinary team meeting (MDT) where different specialists will consider the best treatment options for you. 

CUP is a cancer that has already spread to other parts of the body. Treatment for CUP can improve symptoms and help extend life. It does not usually cure the cancer. 

Treatment aimed at improving symptoms and extending life is known as palliative treatment.

Your clinical team will discuss this with you. They will also ask if you would like to discuss any other needs so they can arrange the right care and support for you outside hospital. This is known as a holistic needs assessment (HNA).

Holistic needs assessment (HNA)

When you have cancer, you may want advice or support with other areas of life – not just your cancer treatment. A holistic needs assessment is a chance for you to talk about any worries or concerns you may have.

Your clinical team will ask if you would like a holistic needs assessment (HNA) to talk about any other needs you have. These could be:

  • Physical 
  • Emotional 
  • Financial 
  • Social
  • Spiritual

You do not have to tell us anything you do not want to tell us. 

If you do have a holistic needs assessment, your clinical team will arrange advice and support to help with your needs. This could include telling you about other organisations that can help or arranging a referral for you. 

Genomics and cancer

Genomics is the study of a person’s genes (or ‘genome’) – the material in DNA that makes each person unique. Cancer is caused by changes in the DNA of a cell and tell it to multiply out of control. 

Understanding where this change has occurred – for example, which gene is faulty – can help us know which treatment will give you the best chance of killing the cancer cells and stopping new ones from growing. 

Your clinical team may arrange for you to have a test known as whole genome sequencing. This can help to identify where the cancer began (primary cancer). Knowing where the cancer began helps us to know what treatments may be best. 

Your clinical team will explain this to you in more detail at your appointment. 

Our treatments

Palliative treatment options can include one or more of the following:

  • Surgery – this may be before, during or after other treatments
  • Drug therapies such as chemotherapy and immunotherapy. The general term for these is systemic anti-cancer therapies (SACT)
  • Radiotherapy 
  • Steroids

Deciding about treatment

Your doctor will discuss your treatment options with you so you can decide what is right for you. 

Sometimes the disadvantages of treatment may outweigh the benefits. For example, your body may not be strong enough to cope with cancer treatments. 

Sometimes people with CUP decide not to have treatment. 

If you are not well enough for cancer treatment – or you decide not to have treatment – we will do everything we can to keep you comfortable and to help you cope with your symptoms.  

Systemic anti-cancer therapy (SACT)

SACT is a term used to describe the different drug therapies for cancer. These include: 

  • Chemotherapy – which aims to kill cancer cells
  • Immunotherapy – which aims to train your immune system to attack cancer 
  • Targeted therapies – which aim to target the DNA and cell changes that cause cancer. For example, BRAF targeted therapy which blocks a protein linked to cancer cells

Radiotherapy

Palliative radiotherapy may be used if your tumour is causing localised symptoms such as pain. We use different types of radiotherapy, depending on the size, location and stage of the cancer. 

The palliative radiotherapy treatments we offer include:

  • Traditional external beam radiotherapy – where radiation is delivered from outside the body
  • Stereotactic ablative radiotherapy (SABR) – a way of very precisely targeting radiotherapy to certain cancers

Clinical trials

Research and trials of new cancer treatments are an important part of our work. Your consultant will tell you about any clinical trials that may be suitable for you.

You are also very welcome to ask us about clinical trials during your appointments. We will be happy to answer any questions you have. 

Find out more about clinical trials. 

Treatment locations

We have a multi-site model where we visit hospitals across Cheshire and Merseyside to provide treatment and consultations closer to patients’ homes. 

We provide systemic anti-cancer therapies (e.g. chemotherapy and immunotherapy) for cancer of unknown primary (CUP) at the following sites:

We provide radiotherapy for breast cancer in our three specialist sites: 

Clinical trials for CUP are delivered at Clatterbridge Cancer Centre – Liverpool.

The team consists of clinical oncologists, medical oncologists, a nurse consultant, clinical nurse specialists, radiographers, pharmacy, research practitioners, administrative support and a cancer support worker. 

Our operational management team makes sure the service runs smoothly.

Consultants 

Medical Oncologists

Dr Eliyaz Ahmed – Multidisciplinary team (MDT) lead
Dr Alia Alchawaf

Nurses 

Nurse Consultant

Alison Taylor – Site reference group lead*

Clinical Support Worker

Sarah Turner

MDT Coordinator

Therese Otty

*The site reference group is where The Clatterbridge Cancer Centre’s specialist cancer of unknown primary team meet to discuss care.

Patient information leaflets

Information for patients with cancer of unknown primary

Other support

Our Cancer Information and Support Centres can provide individualised help and support for patients and families affected by cancer. The team’s main base is in Clatterbridge Cancer Centre – Liverpool but they also work at our Aintree and Wirral hospitals.

There are also local Macmillan services in other hospitals across our region.

External sites that offer extra support and information about cancer of unknown primary include:

Our Cancer of Unknown Primary (CUP) team accepts referrals from healthcare professionals across Cheshire and Merseyside.

Referral information

Email the Cancer of Unknown Primary MDT

The Cancer of Unknown Primary MDT meeting is at 12:00pm (midday) on Thursdays. The referral deadline is 10:00am on Wednesday. 

Information for health professionals

Our Cancer of Unknown Primary team provide the following services:

  • Cheshire and Merseyside Cancer Alliance Cancer of Unknown Primary Specialist MDT meeting 
  • Specialist advice and guidance about diagnosis and treatment of patients with CUP
  • Weekly specialist regional CUP clinic
  • Treatment planning and delivery
  • Emotional and psychological support for CUP patients and their carers
  • Holistic needs assessment (HNA) – understanding each patient’s concerns and needs so we can share information and provide care in the right way for them
  • Clinical research and audit
  • Education and training
  • Whole genome sequencing – DNA tests to try and identify the primary cancer and/or understand how best to treat CUP

Policies, pathways and guidelines 

Clinical guidance on cancer of unknown primary (Cheshire and Merseyside Cancer Alliance)