INFO & BLOG
About diagnosis, treatment and recovery
What exactly does cancer of unknown primary (CUP) mean?
CUP refers to a picture in which a metastatic cancer is detected but, despite comprehensive investigation, its origin (primary focus) cannot be found.
Why can the primary focus not always be found, and how does this affect treatment?
The primary focus may be very small, may regress or stay hidden; therefore treatment is planned according to origin estimation and the council’s decision.
How do immunohistochemistry and molecular profiling estimate the origin?
Broad immunohistochemistry panels and molecular profiling/gene expression analysis provide clues to the most likely tissue origin, making treatment selection possible.
How does gene expression analysis contribute to treatment selection?
It estimates the likely origin and identifies molecular targets to guide treatment, enabling origin-directed systemic therapy.
How are immunotherapy or targeted therapy planned without finding the primary?
Immunotherapy and targeted therapy are evaluated in the council according to the estimated origin and the targets identified in the molecular profile.
In which situations are surgery and radiotherapy considered in CUP?
When local control is needed, surgery and radiotherapy with the TrueBeam LINAC (IMRT/SBRT/SRS) are considered; the indication is determined in the council.
Why is the council’s role in CUP more decisive than in other cancers?
Because the primary focus is unknown, the information to guide treatment is missing; interpreting all findings and determining the treatment order is the council’s central task.
If the primary focus is later found during treatment, does the plan change?
If the primary later emerges, the council reassesses the plan and may update treatment in an origin-specific way.
Which documents and samples (blocks/slides) are needed for a second opinion?
Pathology blocks/slides, existing imaging (including PET-CT) and reports should be shared for origin investigation and council evaluation.
How do the process and follow-up work for international patients?
End-to-end support with remote file review, visa, transfer, accommodation and medical interpreter; follow-up continues via tele-oncology.