Chemotherapy for cancer of unknown primary
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. It’s the most commonly used treatment for CUP. If there are indications of the type of primary cancer you may have, you'll usually be given the chemotherapy drugs used to treat that cancer.
You may be given a chemotherapy drug on its own or a combination of drugs. Some of the drugs used to treat CUP are:
How chemotherapy is given
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Chemotherapy drugs are usually given by injection into a vein (intravenously) or sometimes as tablets. The drugs are absorbed into the blood and carried around the body treating cancer cells in different areas.
Intravenous chemotherapy can be given through a small tube (cannula) in your hand or arm or sometimes through a flexible plastic tube called a central line or PICC line. A central line sits in a vein just under your collarbone at the top of your chest. A PICC line is put into a vein in the bend of your arm and threaded through until it reaches a vein in your chest.
Some chemotherapy drugs are given continuously through a central line or a PICC line attached to a small pump. The pump allows a low dose of the drug to be given day and night while you’re at home. It can be carried in a small bag strapped around your waist or over your shoulder.
Chemotherapy is usually given as several sessions of treatment. On the first day of each treatment you’ll usually be given chemotherapy by injection or infusion. This may be followed by a continuous infusion of chemotherapy or chemotherapy tablets to take at home.
Each treatment is followed by a rest period of a few weeks to allow your body to recover from any side effects. The treatment and the rest period together make up a cycle of treatment. The number of cycles you have will depend on the drugs that are used and how well the treatment is working. This is checked by your doctor regularly. Most people can have chemotherapy as an outpatient.
A number of research trials are being carried out to try to improve the results of chemotherapy treatment for CUP. You may be invited to take part in a trial.
Chemotherapy can cause side effects but it can also make you feel better by relieving symptoms caused by the cancer. Most people have some side effects, but these can often be controlled with medicines. Some of the side effects are described here along with some of the ways they can be reduced.
Risk of infection
Chemotherapy can temporarily reduce the number of white blood cells in your blood. When these cells are reduced, you’re more likely to get an infection, so it’s important to avoid crowded places and anyone with an infection such as a cold or flu.
Contact your doctor straight away if you have any signs of infection, such as a high temperature (above 100.4°F or 38°C), or if you suddenly feel unwell, even with a normal temperature. During chemotherapy, the level of white blood cells in your blood will be checked regularly and, if necessary, you will be given antibiotics to treat any infection.
Bruising or bleeding
Chemotherapy can temporarily reduce the number of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding such as nosebleeds, bleeding gums, blood spots or rashes on the skin.
Anaemia (low number of red blood cells)
You may become anaemic while having chemotherapy. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. Anaemia can be treated with blood transfusions. These should help you feel more energetic and ease any breathlessness.
You may become very tired and have to take things more slowly. Make sure you get plenty of rest but try to balance this with some gentle exercise such as short walks, which can help give you more energy. Our section on coping with fatigue has some helpful tips.
Feeling sick (nausea)
Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to stop you feeling sick (nausea) or being sick (vomiting). Let your doctor or nurse know if your anti-sickness drugs are not helping you, as different types can be tried. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem. Our section on controlling nausea and vomiting has some helpful information about preventing or reducing this side effect.
Some chemotherapy drugs irritate the lining of the bowel and may cause diarrhoea for a few days. Your doctor can give you medicine that slows down your bowel and reduces diarrhoea. You may also be able to help to control it by eating a low-fibre diet. This means avoiding wholemeal bread and pasta, raw fruit, cereals and vegetables for a few days after each treatment.
If you’re having your chemotherapy tablets at home and have diarrhoea, contact your doctor or nurse straight away.
There are more tips and low-fibre recipe ideas in our eating well section.
Sore hands and feet
The chemotherapy drugs 5FU and capecitabine may cause soreness of the palms of the hands or soles of the feet. This is called palmar-plantar syndrome. It’s temporary and will improve after treatment finishes. Using unperfumed moisturising creams can often help to relieve symptoms.
Some drugs can make your mouth sore and cause ulcers. It’s important to look after your mouth and teeth by keeping them clean. Using mouthwashes regularly can help. Your nurse will show you how use these and explain how to look after your mouth. Brush your teeth regularly and use a toothbrush with soft bristles to protect your gums from cuts.
Eating foods that are soft and moist and avoiding dry, salty or highly spiced foods can also help. If you don’t feel like eating because your mouth is sore, you can try replacing some meals with nutritious drinks.
You may find our section on mouth care helpful.
Some chemotherapy drugs can cause hair loss. If you lose your hair, it will start to grow back within 3-6 months of finishing your treatment. People who lose their hair may choose to cover up their hair loss with wigs, bandanas, hats or scarves.
If you’re being treated as an inpatient or are on income support, you can get a free wig from the NHS. If not, you can get a subsidised one from the hospital.
You may find it helpful to read our section on coping with hair loss.
Numbness or tingling in the hands and feet
This is due to the effect of some chemotherapy drugs on nerves and is called peripheral neuropathy. You may also notice that you have difficulty doing up buttons or doing other fiddly tasks. Tell your doctor if you notice any numbness or tingling in your hands or feet. This usually improves slowly a few months after treatment ends but is sometimes permanent.
If you’re a woman who hasn’t been through menopause, you may find that chemotherapy brings it on. Signs of the menopause include symptoms such as hot flushes and sweats. Some women can have hormone replacement therapy (HRT) to replace the hormones no longer being produced. You can discuss this with your cancer specialist or nurse.
It’s not advisable to become pregnant or father a child while having chemotherapy as the drugs may harm an unborn baby. It’s important to use effective contraception during your treatment and for a few months afterwards. You can discuss this with your doctor or nurse.
Condoms should be used if you have sex within the first 48 hours after chemotherapy. This it to protect your partner from any trace of the chemotherapy drugs, which may be present in semen or vaginal fluid. It’s not proven that drugs can pass into this fluid, but using condoms is currently recommended by doctors.