Chemotherapy for cancer of unknown primary
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.
Cancer of unknown primary (CUP) is an advanced cancer. This means that unfortunately, it cannot be cured. The aim of treatment is generally to relieve symptoms rather than cure the cancer. It can also control the cancer and improve quality of life.
When you have it
You usually have chemotherapy as cycles of treatment. This means that you have one chemotherapy drug or a combination of drugs then a rest to allow your body to recover. Each cycle of treatment varies depending on what you are having. But usually, it’s every 2 to 4 weeks.
When you have chemotherapy and for how long you have it depends on:
- what chemotherapy drugs you are having
- the aim of treatment. For example, if you are having chemotherapy to relieve symptoms or to try to cure your cancer
- the side effects you're having
- how the cancer is responding to treatment
Types of chemotherapy drugs
There are a number of chemotherapy drugs used to treat CUP. The type of drug you have depends on different factors such as:
- the results of all your tests
- the side effects of the drugs
- your general health and fitness
- whether you have other medical problems such as heart problems
Examples of chemotherapy for CUP include:
- carboplatin and paclitaxel
- gemcitabine and carboplatin or cisplatin
- epirubicin, cisplatin and capecitabine (ECX)
- epirubicin, cisplatin and fluorouracil (ECF)
- irinotecan and gemcitabine or oxaliplatin
You might have other types of chemotherapy if you have cancer spread that is similar to other types of cancer. For example, cancer spread to the lymph nodes of your armpit is considered similar to breast cancer. You may hear doctors call this a specific treatable syndrome. But most people with CUP do not have a specific treatable syndrome. Your doctor will always plan the best treatment for you.
Chemotherapy for cancer spread in the lymph nodes of the armpit
Your doctor may refer you to a breast cancer specialist if you have a type of cancer called adenocarcinoma in the lymph nodes of your armpit. This is because the cancer might have started in your breast.
You usually have a combination of chemotherapy drugs such as paclitaxel and doxorubicin.
Chemotherapy for cancer spread in the layer of tissue around the tummy
This layer of tissue is called the peritoneum. If you have cancer cells in this layer of tissue your doctor may refer you to a team that specialises in cancers of the female sex organs. The team is called the gynae oncology team.
You might have a platinum drug alongside paclitaxel or docetaxel. Platinum drugs include cisplatin or carboplatin.
Chemotherapy for cancer spread in the area between the lungs or the back wall of the tummy
The area between your lungs is called the mediastinum. And the back wall of the tummy or abdomen is called the retroperitoneum. If you have cancer cells in either of these areas it might suggest that your cancer started in cells that make sperm in the testicles, or eggs in the ovaries. These are called 
.
You usually have a combination of chemotherapy that includes the drugs cisplatin or carboplatin.
Chemotherapy for cancer spread in the lymph nodes of the neck
This might suggest that the cancer started in your head and neck area. For example, it might have started in the tonsils. Your doctor will usually refer you to the head and neck team for treatment.
You might have the chemotherapy drug cisplatin or carboplatin, alongside radiotherapy. This type of treatment is called chemoradiotherapy.
Chemotherapy for cancer that might have started in the neuroendocrine system
Cancer can sometimes develop in cells of the . If your doctor thinks you have this, they might refer you to a medical team that specialises in neuroendocrine tumours.
You might have treatment with paclitaxel, carboplatin or etoposide.
How you have chemotherapy
You usually have chemotherapy through a drip into your bloodstream. Or you might take some chemotherapy drugs as tablets.
Into your bloodstream
You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.
You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.
Taking your tablets or capsules
Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, not more or less.
Talk to your healthcare team before you stop taking or miss a dose of a cancer drug.
Where you have chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.
For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.
Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied, such as books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
Before you start chemotherapy
You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.
Side effects
Common chemotherapy side effects include:
- feeling sick
- loss of appetite
- losing weight
- feeling very tired
- increased risk of getting an infection
- bleeding and bruising easily
- diarrhoea or constipation
- hair loss
Side effects depend on:
- which drugs you have
- how much of each drug you have
- how you react
Tell your treatment team about any side effects that you have.
Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.
When you go home
Chemotherapy can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.
Dietary or herbal supplements and chemotherapy
Let your doctors know if you:
- take any supplements
- have been prescribed anything by alternative or complementary therapy practitioners
It’s unclear how some nutritional or herbal supplements might interact with chemotherapy. Some could be harmful.
