Treatment overview

If CUP is confirmed, it can be very hard to accept that even with tests, the doctors still don’t know what the primary cancer is. You’ll probably be feeling lots of different emotions, so it’s important to get the support you need. Some people may feel relieved that the tests are over and treatment can now start.

The aim of treatment is to try to control the cancer, help you live longer and treat your symptoms. Your specialist will look at different factors before advising on the best treatment for you. They will consider where the secondary cancer(s) are. They will also weigh up how likely you are to benefit from the treatment and how you might cope with any side effects. Usually the main treatment for CUP is chemotherapy. Radiotherapy, hormonal therapy, rarely targeted therapy, and sometimes surgery, may also be used.

Supportive or palliative care, using medicines to control your symptoms, is an important part of treatment for people with CUP. It is sometimes given alongside chemotherapy or radiotherapy treatment. We have more information about treatment to control the symptoms of CUP.

It’s important to have enough information to help you make your decision. We have more information to help you make treatment decisions.

Treatment for certain types of cancer

Knowing where the secondary cancer is, your symptoms, the cell type and test results may give a strong indication of where the cancer may have started. In this case, your doctors may plan treatment that is used for that type of cancer.

For example, if a woman has an adenocarcinoma in the peritoneum (the membrane that lines the inside of the tummy) and has a raised CA125 level, this may indicate an ovarian cancer. CA125 is a tumour marker. In this situation, your specialist may suggest treatment with chemotherapy that is given for ovarian cancer.

Or if a man has a raised PSA level and adenocarcinoma in the bones, he may be treated with hormonal therapy for prostate cancer. PSA is also a tumour marker.

Small areas of CUP

Some people may have a type of CUP that has a much better outlook with treatment, even when the primary can’t be found.

This is usually when the secondary cancer is only in a small area of the body, such as the lymph nodes. For example:

  • Squamous cell lymph nodes in your neck may mean the primary cancer is in the head and neck area. You will be referred to a head and neck specialist team for assessment. You may have surgery to remove the lymph nodes or have radiotherapy. Or you may have a combination of the two. Chemotherapy may also be given.
  • Adenocarcinoma in lymph nodes in one armpit may mean the primary cancer is in the breast. You will be referred to a specialist breast cancer team for assessment. You may have surgery or radiotherapy to the lymph nodes, then chemotherapy and hormonal therapy.
  • Squamous cell lymph nodes in the groin may mean the cancer started in the groin area or in the back passage. You will be referred to a specialist surgeon to have the nodes removed, which may be followed by radiotherapy.

It’s a scary time when you don’t know exactly what you’re dealing with, but I found that once treatment started it was easier to think positively.


Palliative care

The aim of palliative care is to control symptoms and to improve or maintain your quality of life. Sometimes doctors advise having palliative care on its own rather than treating the cancer. This may be because the cancer is very advanced and they believe that the disadvantages of treatment outweigh any possible benefits. Or the person may be too ill to have treatment.

There are palliative care nurses available in the hospital and they can also come to your home. They are experienced in assessing and treating symptoms of advanced cancer.

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