Controlling the symptoms of CUP

The main aim of treatment for CUP is often to control symptoms. This is called supportive care or palliative care. These symptoms may include:

  • tiredness
  • weight loss
  • loss of appetite
  • pain
  • feeling sick.

If the cancer has spread to your bones, you may be given a type of drug called a bisphosphonate. This can help reduce any bone pain and strengthen your bones.

Sometimes steroids are used to help relieve certain symptoms and may also be used as part of chemotherapy treatment. It is important to take steroids exactly as prescribed by your doctor.

Doctors and nurses who specialise in controlling symptoms like these are called palliative care specialists. They work with your GP and other healthcare professionals to try to make sure your symptoms are well controlled. It is important to let your specialist know about any symptoms you may have.

As well as coping with the symptoms of CUP, you’ll probably be dealing with lots of different feelings. You might find it helps to talk to someone close to you or others in a similar situation.

Supportive or palliative care

For many people with CUP, the main aim of their treatment is to control symptoms. Treating symptoms is known as supportive care or palliative care. Some people with CUP may decide to have supportive care on its own without cancer treatments. You can also have supportive care alongside cancer treatments and after they are finished.

Doctors and nurses who specialise in controlling pain and other symptoms are called palliative care specialists. They are based in hospitals, in the community, hospices, palliative care units and pain clinics. They work with your GP, district nurses and other healthcare professionals to try to make sure your symptoms are well controlled. Palliative care nurses can also come to visit you in your own home. Your GP or cancer specialist can usually arrange this for you.


Many people with CUP feel very tired (fatigued) and may have less energy to do the things they normally do. This may be due to the illness or may be a side effect of the treatment.

Your body will tell you when you need to rest. When you do feel like doing things, try to pace yourself. You may find it helpful to keep a diary, so you can record your energy levels and plan activities for when you are feeling stronger.

Some causes of tiredness can be treated, for example, anaemia (low number of red blood cells) can be treated with a blood transfusion. A blood transfusion is when you are given the blood cells through a drip into your vein. This will increase the number of red blood cells in your blood. It can be done in an outpatient clinic or in hospital overnight. Your doctor can take a blood sample from you to find out if you are anaemic.

Coping with pain is tiring and affects the quality of your sleep. Finding ways to manage your pain can help you feel better and improve your energy levels. It will also help you to get a good night’s sleep.

Tiredness is a common symptom of depression. If you think you are depressed, talk to your doctor or nurse. Talking about your feelings with a professional counsellor can also often help depression and anti-depressants may also help you feel better.

We have some helpful tips on how to cope with tiredness.

Loss of appetite and weight loss

Many people with cancer find that there are times when they can’t eat as much as usual, and sometimes lose weight.

It can help to add high-protein powders to your food or to supplement your meals with nutritious, high-calorie drinks. These are available from most chemists and can be prescribed by your GP. If you find it difficult to eat a lot at once, try eating several small meals and snacks during the day rather than three large meals. Sometimes a small dose of steroids can help boost your appetite. You can talk to your doctor about whether this might help.

You can also ask to be referred to a dietitian at your hospital. They can advise you which foods are best for you and whether any food supplements would help. If you are at home, your GP can arrange this for you. We can send you more information about diet and help with eating problems.


Pain can usually be well controlled. If you’re in pain, it is important to let your doctor or nurse know so that you can be given treatment to help. Information about your pain will help your doctor or nurse assess you and plan your treatment. You may want to tell them:

  • how your pain rates on a scale of 0 (no pain) to 10 (worst pain)
  • which words best describe your pain – for example, is it dull, sharp, shooting or aching?
  • what makes the pain better or worse
  • how your pain affects everyday activities.

There are different types of pain relief drugs that can be used to treat different types of pain. Painkillers come in different forms, including tablets, liquid medicines and skin patches. They can also be given by injection or infusion into a vein.

Painkillers often cause constipation, so it’s important to try to have a diet high in fibre and to drink plenty of fluids. Your doctor should also prescribe a laxative with your painkillers to prevent constipation.

Cancer treatments such as chemotherapy or radiotherapy can also be used to relieve pain. They work by shrinking the cancer, but it may be a few weeks before you begin to feel the benefits.

Some people find complementary therapies can also help with managing pain.

We have more information on coping with pain.

Feeling sick (nausea)

This can usually be relieved effectively by anti-sickness medicines (anti-emetics). There are different types available and your doctor will find the one that suits you best. We have more information about coping with sickness.

Bone pain

You might be given drugs called bisphosphonates if the cancer has spread to your bones. They help with bone pain and can help strengthen your bones. Bisphosphonates can be given as a drip into a vein in an outpatient clinic. Some bisphosphonates are taken as tablets or capsules.

Denosumab is another treatment that may be used if a cancer has spread to the bones. It is given as an injection under the skin (subcutaneously).


Steroids can be used to help relieve certain symptoms and are sometimes used as part of chemotherapy treatment. Your doctor may suggest that you take them early in the day as they can stop you from sleeping at night. It is important to take steroids exactly as prescribed by your doctor. You will have regular appointments with your doctor to monitor the effect of the steroids.

If you have to take steroids for a long period of time, your doctor will give you a card to carry. The card should be carried with you at all times so that in an emergency a doctor will know you are having steroid treatment. A card is not necessary if you are only having a short course of steroids. It’s important not to stop taking steroids without checking with your doctor as the dose usually needs to be reduced gradually.

We have more information about steroids.

Coping with CUP

As well as coping with side effects of treatment or some of the symptoms we’ve mentioned, you’ll probably be dealing with lots of different feelings. Coping with CUP can be particularly difficult because there’s so much uncertainty. We have more information to help you cope with these difficult feelings.

It is often hard to understand the illness itself and to make sense of the different tests you are having. Trying to explain things to your family and friends when you don’t have clear answers yourself can be difficult.

You might find it helpful to talk to others in a similar situation. Our online community has a group specifically for people affected by CUP.

You might also find it helpful to contact the Cancer of Unknown Primary Foundation - Jo's Friends. It has an area on its website where you can connect with other people. This may help you feel less isolated.

Back to Treating

Decisions about treatment

Your doctors may tell you there are different options for your treatment. Having the right information will help you make the right decision for you.


Chemotherapy uses anti-cancer drugs to destroy cancer cells. It is the most commonly used treatment for CUP.


Radiotherapy uses high-energy rays to destroy cancer cells. It aims to treat cancer or relieve symptoms.


Surgery is not commonly used to treat CUP. Your doctor will talk to you about surgery if it is an option for you.

Clinical trials

Some people are offered a trial as part of treatment. Find out more to help you decide if a trial is right for you.