3. Further referral and testing
Cancer of unknown primary (CUP) is when cancer cells are found in the body but the place the cancer began is not known.
If CUP is detected, to ensure you receive the best care, your specialist may need to refer you to another doctor. The doctor will be part of a team made up of professionals who have experience managing and supporting a person with CUP (if not specialising in this area themselves), or in a specialist cancer centre.
Because CUP has already spread, further tests are usually done, based on the site of the secondary cancer/s and any ‘clues’ as to where the cancer may have started from your initial tests. Tests are ordered to ensure that cancers which are still curable or treatable, even when spread, are not missed.
Your team will plan further tests and treatment based on your preferences, symptoms, and previous test results. Your specialist will tell you when the team will be discussing your case.
You may have one or more of the following tests (some of these tests are not covered by Medicare):
- Tumour marker test
- Positron emission tomography (PET) scan
- Magnetic resonance imaging (MRI) scan
- Computed tomography (CT) scan/bone scan
- Gastroscopy and/or colonoscopy
A sample of blood or tissue is checked to measure the amounts of certain substances made by tumour cells in the body.
This uses high-frequency sound waves to make an image of a person’s internal body structures.
This produces a three-dimensional image that may show where cancers are located. A small amount of radioactive material is injected, and the whole body is scanned.
Magnetic fields and radio waves are used to take pictures of inside the body.
Computer technology and x-rays are used to create detailed images of the body.
A long flexible tube with a camera on it (called an ‘endoscope’) is inserted via your mouth or anus under a light general anaesthetic, and the images appear on a screen.
Some people have further tests such as a bronchosopy or mammogram.
Sometimes, these tests will find the primary cancer at the time of diagnosis or sometimes it might be found later in the course of the illness. When this happens, the cancer is no longer called CUP and is treated according to the place of origin.
If your specialist can’t be sure of the primary cancer, they may be able to suggest a possible part of the body where the cancer started (based on where the secondary cancers are, your symptoms and the test results). This will help your team to plan your treatment.