CUP / MUO
Definition:
- Where the primary site remains unclear following comprehensive investigations, a patient is said to have a cancer of unknown primary (CUP).
| Clinicopathological features |
Management |
Women with
- serous papillary adenocarcinoma of the peritoneal cavity
- isolated adenocarcinoma of axillary LNs
|
- Treat like ovarian cancer
|
Men with
- poorly differentiated carcinoma with midline distribution
- blastic bone metastases or elevated prostate-specific antigen
|
- Treat like germ cell cancer
- Treat like prostate cancer
|
For both:
- Poorly differentiated neuro-endocrine carcinoma of unknown origin
- Well-differentiated neuro-endocrine tumor (NET)
- SCC of non supraclavicular cervical LNs
(upper)
- Adenocarcinoma with a colorectal-IHC profile (middle)
- Inguinal adenopathy squamous carcinoma (lower)
|
- Treat like small cell cancer
- Treat with somatostatin analogues
- Treat like head and neck SCC
- Treat like anogenital squamous cancer
|
- Patients with one small, potentially resectable tumors
|
- Assess for surgical resection
|
Management:
- ot wait for definitive diagnosis
- Analgesia
- Radiotherapy
- Surgery
- Palliative
- Systemic chemotherapy:
Features of poor prognosis
- Poor performance status (PS 3–4),
- Requirement for hospital admission,
- Bulky or multi-organ metastatic disease,
- Significant comorbidity,
- Raised LDH,
- Raised inflammatory markers and
- Low albumin.
