Being diagnosed with CUP

Your GP will examine you and refer you to a specialist in hospital for more tests. The specialist will ask you about your general health and your family history. The type of specialist you see will depend on your symptoms.

Once a cancer is diagnosed but doctors are not sure where the cancer first started, you may be referred to a specialist CUP team. You may have tests such as blood tests, x-rays and scans. These will help doctors plan the best treatment for you.

Having tests can take up a lot of time and energy. If your doctor thinks having more tests may not be helpful, they may suggest you start treatment rather than have more tests. Your specialist may suggest you have treatment to help manage symptoms, rather than treat the cancer.

Waiting for test results and making decisions about treatment can be difficult. You may find it helps to talk to your specialist nurse or someone close to you.

How CUP is diagnosed

If you have symptoms, you usually begin by seeing your GP, who will examine you and ask you about your symptoms. They will refer you to hospital for tests and for specialist advice and treatment. Many people are admitted directly to hospital if they have a symptom that’s making them very unwell. In this situation, tests may be carried out as an inpatient.

The type of specialist doctor you’ll be referred to will depend on your symptoms. For example, if you have bowel or stomach symptoms, you’ll usually be referred to a gastroenterologist, who treats problems of the digestive system. Or if you have kidney or bladder symptoms, you’ll see a urologist.

Once a cancer is diagnosed but it’s unclear where the primary cancer is, people may then be referred to a specialist CUP team.


At the hospital

The specialist will ask about your general health, and you and your family’s medical history. They will examine you and you may also have blood tests, x-rays and scans.

Women may have a mammogram of their breast or a pelvic examination. Men may have a blood test to measure a protein called a prostate specific antigen (PSA) and have a prostate examination.

Your specialist will usually arrange for you to have some different types of tests. When tests show a suspected cancer, you will usually have some tissue or cells removed to be examined under a microscope for cancer cells. This is called a biopsy. Some people with suspected CUP may be too unwell to have many of these tests. This may be because the cancer is very advanced or they may have other health problems.

The specialist team might suggest you have treatment to relieve your symptoms rather than to treat the cancer. If you decide to have this, you may not need many tests. Treatment to control symptoms is known as supportive or palliative care.

You are usually introduced to a specialist nurse and given their contact details.


Making decisions about tests

Your doctors will want to find out as much as they can to help them plan the best treatment.

They will usually look for the most obvious primary cancers first. The tests you have will depend on your symptoms and where the secondary cancer(s) are.

Your doctor may look at whether you have a strong family history of a certain cancer or a condition that increases your risk. They will also take your lifestyle into account, for example if you smoke or if a past occupation could have exposed you to asbestos or chemicals that increase the risk of certain cancers.

If the primary cancer isn’t obvious, your doctors will need to do a series of tests. These will often be done in a particular order. Your specialist will use national guidelines to decide which tests are appropriate for you. The results of one test may suggest that another one would be useful. If the first tests don’t show which type of cancer you have, your doctors may try different tests for less obvious cancers. The tests you may have will vary from person to person.

Having tests can take up a lot of your energy and time. You may choose not to have them if they aren’t likely to make a difference to your overall treatment or care.

If your specialist thinks that having more tests may not be helpful, they might advise you to start treatment rather than have more tests. Or they may feel that you are too poorly to continue with more tests and it would be better for your symptoms to be managed by a palliative care team.

We have more information about the different tests and scans you might have.

Back to Diagnosing

Tests and scans for CUP

Having further tests may help doctors find out more about where the cancer first started.