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Treatment decisions

Find out how your medical team decides on the treatment you need, and the types of treatment you might have for cancer of unknown primary (CUP).

Deciding which treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The treatment you have depends on:

  • where your cancer is
  • if it has spread to more than one area of the body
  • where your doctor thinks the cancer may have started
  • how abnormal the cells look under a microscope
  • your general health and level of fitness
  • your personal wishes

Your doctor will discuss your treatment, its benefits and the possible side effects with you.

Unfortunately, most cases of CUP can’t be cured. But treatment can control it, relieve symptoms, and give you a good quality of life for a while. 

If doctors think your cancer can't be cured, and you don't have many side effects, they might suggest to hold off treatment for a while.

Finding out that your cancer can't be cured can be a big shock. It might help to talk to a close friend or relative about how you feel.

We're here for you if you or someone close to you has cancer. You can call our Cancer Research UK nurses on 0808 800 4040, from Monday to Friday, 9am to 5pm.

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.

Chemotherapy is the main treatment for cancer of unknown primary. You often have a combination of 2 or 3 chemotherapy drugs.

Hormone treatment

The doctor in the laboratory may test your cancer cells for special proteins on the surface (hormone receptors).

Cancers that are most likely to have hormone receptors are breast cancer, prostate cancer and womb cancer. If your cancer cells have these receptors, your doctor might suggest you have hormone treatment to help control the cancer.

Radiotherapy

Radiotherapy uses high energy rays to kill cancer cells. Doctors often use radiotherapy to help treat symptoms caused by the cancer, such as breathing problems or pain.

You may have radiotherapy after surgery or chemotherapy to control the cancer. In certain situations, when the cancer is only in the lymph nodes in one area, such as the neck, doctors may give radiotherapy to try to cure the cancer.

Depending on why you are having radiotherapy, you may have a single treatment to the area of cancer or a course of treatments over several days or weeks.

Surgery

Surgery is not often used to treat CUP. This is because:

  • the position of the primary cancer is not known
  • doctors can't usually remove all the secondary cancers

But doctors may offer it in particular circumstances. For example, if tests on a swollen (enlarged) lymph node show that you might have a squamous cell cancer in your head or neck, you might have surgery to remove the node and other nodes nearby. The surgeon would try to remove all signs of cancer from the area. It’s possible that this type of surgery could cure some people with CUP.

You often have a course of radiotherapy to the area after this operation. The radiotherapy is to try to kill off any cancer cells that may have been left behind. Occasionally you might also have radiotherapy to the area in the head or neck where your doctor thinks the primary cancer is most likely to be.

In other situations, your doctor may suggest surgery to relieve symptoms such as bleeding or blockages in the body caused by the cancer.

Clinical trials

Your doctor might suggest you take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

Treatment for symptoms

You might have other treatments to help control symptoms, such as painkillers, anti sickness drugs or steroids. Your doctor might call this supportive care. You might have this with the cancer treatments mentioned above, or on its own.

Some people with advanced cancer might not be well enough to have some cancer treatments such as chemotherapy. Or they may choose not to have this kind of treatment. People can decide not to have treatment because of a number of reasons. For example, they may feel that the side effects of treatment outweigh the possible benefits.

Your medical team, including your specialist nurse, will support you. They give you the information you need to make any decisions about treatment and answer any questions you have.

Your choices

Your doctor might offer you a choice of treatments. Discuss the advantages and disadvantages of each treatment with them and ask how they can control any side effects. This helps you make the right decision for you. You also need to think about the other factors involved in each treatment, such as:

  • whether you need extra appointments
  • if you need more tests
  • the distance you need to travel to and from hospital

You might have to make further choices as your situation changes. It helps to find out as much as possible each time. You can stop a treatment whenever you want to if you find it too much to cope with.

If you decide not to have treatment

You may decide not to have cancer treatments, such as chemotherapy. But you can still have medicines to help control symptoms, such as sickness or pain.

Your doctor or nurse will explain what could help you. You can also ask them to refer you to a local symptom control team to give you support at home.

Last reviewed: 
05 Oct 2017
  • Metastatic malignant disease of unknown primary origin in adults: diagnosis and management
    National Institute for Health and Care Excellence (NICE), 2010

  • Cancers of unknown primary site: ESMO clinical practice guidelines for diagnosis, treatment and follow up
    K Fizazi and others
    Annals of Oncology, 2015. Vol 26, Supplement 5

  • Cancer: Principles and Practice of Oncology (10th edition)
    VT DeVita , TS Lawrence, SA Rosenberg
    Lippincott, Williams and Wilkins, 2015

  • Cancer and its Management (7th edition)
    J Tobias and D Hochhauser
    Wiley-Blackwell, 2015

  • Overview of the classification and management of cancers of unknown primary site

    J Hainsworth and others ​

    UpToDate, 2017

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