21st Century Adult Cancer Sourcebook: Carcinoma of Unknown Primary (CUP), Occult Primary Malignancy - Clinical Data for Patients, Families, and Physicians
Edition 1.0 - September 2011
National Cancer Institute
Smashwords Edition
Copyright 2011 Progressive Management
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OncoLink * http://www.oncolink.upenn.edu/
eMedicine.com * http://www.emedicine.com/
American Cancer Society (ACS) * http://www.cancer.org/
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PART ONE
Chapter 1A: CUP Patient Information
Chapter 2A: CUP Health Professional Information
Chapter 3A: CUP Clinical Trials
PART TWO
Chapter 1B: Levels of Evidence for Adult and Pediatric Cancer Treatment Studies (NCI)
Chapter 2B: Glossary of Clinical Trial Terms
Chapter 3B: Clinical Trials Background Information
Chapter 4B: Cancer Clinical Trials -The Basic Workbook
Chapter 5B: Cancer Clinical Trials - The In-Depth Program
Chapter 6B: Clinical Trials at NIH
Chapter 7B: How To Find A Cancer Treatment Trial: A Ten Step Guide
Chapter 8B: Taking Part in Cancer Treatment Research Studies
Chapter 9B: Cancer Clinical Trials
Chapter 10B: Access to Investigational Drugs
Chapter 12B: Taking Time: Support for People with Cancer
Chapter 13B: Facing Forward - Life After Cancer Treatment
Chapter 14B: Chemotherapy and You
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PART ONE
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Chapter 1A: CUP Patient Information
Carcinoma of Unknown Primary Treatment
Last Modified: 05/26/2011
Patient Version
General Information About Carcinoma of Unknown Primary
Key Points for This Section
* Carcinoma of unknown primary (CUP) is a rare disease in which malignant (cancer) cells are found in the body but the place the cancer began is not known.
* Sometimes the primary cancer is never found.
* The signs and symptoms of CUP are different, depending on where the cancer has spread in the body.
* Different tests are used to detect (find) cancer.
* If tests show there may be cancer, a biopsy is done.
* When the type of cancer cells or tissue removed is different from the type of cancer cells expected to be found, a diagnosis of CUP may be made.
* Tests and procedures used to find the primary cancer depend on where the cancer has spread.
* Certain factors affect prognosis (chance of recovery).
Carcinoma of unknown primary (CUP) is a rare disease in which malignant (cancer) cells are found in the body but the place the cancer began is not known.
Cancer can form in any tissue of the body. The primary cancer (the cancer that first formed) can spread to other parts of the body. This process is called metastasis. Cancer cells usually look like the cells in the type of tissue in which the cancer began. For example, breast cancer cells may spread to the lung. Because the cancer began in the breast, the cancer cells in the lung look like breast cancer cells.
Sometimes doctors find where the cancer has spread but cannot find where in the body the cancer first began to grow. This type of cancer is called a cancer of unknown primary (CUP) or occult primary tumor.
Tests are done to find where the primary cancer began and to get information about where the cancer has spread. When tests are able to find the primary cancer, the cancer is no longer a CUP and treatment is based on the type of primary cancer.
Sometimes the primary cancer is never found.
The primary cancer (the cancer that first formed) may not be found for one of the following reasons:
* The primary cancer is very small and grows slowly.
* The body’s immune system killed the primary cancer.
* The primary cancer was removed during surgery for another condition and doctors didn’t know cancer had formed. For example, a uterus with cancer may be removed during a hysterectomy to treat a serious infection.
The signs and symptoms of CUP are different, depending on where the cancer has spread in the body.
Signs and symptoms of CUP may include the following:
* Lump or thickening in any part of the body.
* Pain that is in one part of the body and does not go away.
* A cough that does not go away or hoarseness in the voice.
* Change in bowel or bladder habits, such as constipation, diarrhea, or frequent urination.
* Unusual bleeding or discharge.
* Fever for no known reason that does not go away.
* Night sweats.
* Weight loss for no known reason or loss of appetite.
Other conditions may cause these same symptoms. Sometimes CUP does not cause any symptoms. Talk to your doctor if you have any of these problems.
Different tests are used to detect (find) cancer.
The following tests and procedures may be used:
* Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
* Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, blood, and bacteria.
* Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
* Complete blood count: A procedure in which a sample of blood is drawn and checked for the following:
* The number of red blood cells, white blood cells, and platelets.
* The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
* The portion of the sample made up of red blood cells.
* Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making pictures of areas inside the body.
* Fecal occult blood test: A test to check stool (solid waste) for blood that can only be seen with a microscope. Small samples of stool are placed on special cards and returned to the doctor or laboratory for testing. Because some cancers bleed, blood in the stool may be a sign of cancer in the colon or rectum.
If tests show there may be cancer, a biopsy is done.
A biopsy is the removal of cells or tissues so they can be viewed under a microscope by a pathologist. The pathologist views the tissue under a microscope to look for cancer cells and to find out the type of cancer. The type of biopsy that is done depends on the part of the body being tested for cancer. One of the following types of biopsies may be used:
* Excisional biopsy: The removal of an entire lump of tissue.
* Incisional biopsy: The removal of part of a lump or a sample of tissue.
* Core biopsy: The removal of tissue using a wide needle.
* Fine-needle aspiration (FNA) biopsy: The removal tissue or fluid using a thin needle.
If cancer is found, one or more of the following laboratory tests may be used to study the tissue samples and find out the type of cancer:
* Histologic study: A laboratory test in which stains are added to a sample of cancer cells or tissue and viewed under a microscope to look for certain changes in the cells. Certain changes in the cells are linked to certain types of cancer.
* Immunohistochemistry study: A laboratory test in which dyes or enzymes are added to a sample of cancer cells or tissue to test for certain antigens (proteins that stimulate the body's immune response).
* Reverse transcription–polymerase chain reaction (RT-PCR) test: A laboratory test in which cells in a sample of tissue are studied using chemicals to look for certain changes in the genes.
* Cytogenetic analysis: A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes. Changes in certain chromosomes are linked to certain types of cancer.
* Light and electron microscopy: A laboratory test in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.
When the type of cancer cells or tissue removed is different from the type of cancer cells expected to be found, a diagnosis of CUP may be made.
The cells in the body have a certain look that depends on the type of tissue they come from. For example, a sample of cancer tissue taken from the breast is expected to be made up of breast cells. However, if the sample of tissue is a different type of cell (not made up of breast cells), it is likely that the cells have spread to the breast from another part of the body. In order to plan treatment, doctors first try to find the primary cancer (the cancer that first formed).
Tests and procedures used to find the primary cancer depend on where the cancer has spread.
In some cases, the part of the body where cancer cells are first found helps the doctor decide which diagnostic tests will be most helpful.
* When cancer is found above the diaphragm (the thin muscle under the lungs that helps with breathing), the primary cancer site is likely to be in the upper part of the body, such as in the lung or breast.
* When cancer is found below the diaphragm, the primary cancer site is likely to be in the lower part of the body, such as the pancreas, liver, or other organ in the abdomen.
* Some cancers commonly spread to certain areas of the body. For cancer found in the lymph nodes in the neck, the primary cancer site is likely to be in the head or neck, because head and neck cancers often spread to the lymph nodes in the neck.
The following tests and procedures may be done to find where the cancer first began:
* CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest or abdomen, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
* MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
* PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
* Mammogram: An x-ray of the breast.
* Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope is inserted through an incision (cut) in the skin or opening in the body, such as the mouth. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue or lymph node samples, which are checked under a microscope for signs of disease.
* Tumor marker test: A procedure in which a sample of blood, urine, or tissue is checked to measure the amounts of certain substances made by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the body. These are called tumor markers. The blood may be checked for the levels of alpha-fetoprotein (AFP), beta human chorionic gonadotropin (β-hCG), or prostate-specific antigen (PSA).
Sometimes, none of the tests can find the primary cancer site. In these cases, treatment may be based on what the doctor thinks is the most likely type of cancer.
Certain factors affect prognosis (chance of recovery).
The prognosis (chance of recovery) depends on the following:
* Where the cancer began in the body and where it has spread.
* The number of organs with cancer in them.
* The way the tumor cells look when viewed under a microscope.
* Whether the patient is male or female.
* Whether the cancer has just been diagnosed or has recurred (come back).
For most patients with CUP, current treatments do not cure the cancer. Patients may want to take part in one of the many clinical trials being done to improve treatment. Clinical trials for CUP are taking place in many parts of the country. Information about clinical trials is available from the NCI Web site.
Glossary Terms
abdomen (AB-doh-men)
* The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.
abnormal (ab-NOR-mul)
* Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).
alpha-fetoprotein (AL-fuh-FEE-toh-PROH-teen)
* A protein normally produced by a fetus. AFP levels are usually undetectable in the blood of healthy adult men or women (who are not pregnant). An elevated level of AFP suggests the presence of either a primary liver cancer or germ cell tumor. Also called AFP.
antigen (AN-tih-jen)
* Any substance that causes the body to make a specific immune response.
appetite (A-peh-tite)
* A desire to satisfy a physical or mental need, such as for food, sex, or adventure.
bacteria (bak-TEER-ee-uh)
* A large group of single-cell microorganisms. Some cause infections and disease in animals and humans. The singular of bacteria is bacterium.
beta-human chorionic gonadotropin (BAY-tuh-HYOO-mun KOR-ee-AH-nik goh-NA-doh-TROH-pin)
* A hormone normally found in the blood and urine during pregnancy. It may also be produced by some tumor cells. An increased level of beta-human chorionic gonadotropin may be a sign of cancer of the testis, uterus, ovary, liver, stomach, pancreas, or lung. Beta-human chorionic gonadotropin may also be produced in response to certain conditions that are not cancer. Beta-human chorionic gonadotropin is being studied in the treatment of Kaposi sarcoma. Also called beta-hCG.
biopsy (BY-op-see)
* The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.
bladder (BLA-der)
* The organ that stores urine.
blood (blud)
* A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
blood chemistry study (blud KEH-mih-stree STUH-dee)
* A procedure in which a sample of blood is examined to measure the amounts of certain substances made in the body. An abnormal amount of a substance can be a sign of disease in the organ or tissue that produces it.
bowel (BOW-ul)
* The long, tube-shaped organ in the abdomen that completes the process of digestion. The bowel has two parts, the small bowel and the large bowel. Also called intestine.
breast (brest)
* Glandular organ located on the chest. The breast is made up of connective tissue, fat, and breast tissue that contains the glands that can make milk. Also called mammary gland.
breast cancer (brest KAN-ser)
* Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.
cancer (KAN-ser)
* A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.
carcinoma of unknown primary (KAR-sih-NOH-muh... ... UN-none PRY-mayr-ee)
* A case in which cancer cells are found in the body, but the place where the cells first started growing (the origin or primary site) cannot be determined. Also called cancer of unknown primary origin and CUP.
cell (sel)
* The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.
chest x-ray (chest EX-ray)
* An x-ray of the structures inside the chest. An x-ray is a type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease.
chromosome (KROH-muh-some)
* Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes.
clinical trial (KLIH-nih-kul TRY-ul)
* A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.
colon (KOH-lun)
* The longest part of the large intestine, which is a tube-like organ connected to the small intestine at one end and the anus at the other. The colon removes water and some nutrients and electrolytes from partially digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus.
complete blood count (kum-PLEET blud kownt)
* A test to check the number of red blood cells, white blood cells, and platelets in a sample of blood. Also called blood cell count and CBC.
condition (kun-DIH-shun)
* In medicine, a health problem with certain characteristics or symptoms.
constipation (KON-stih-PAY-shun)
* A condition in which stool becomes hard, dry, and difficult to pass, and bowel movements don’t happen very often. Other symptoms may include painful bowel movements, and feeling bloated, uncomfortable, and sluggish.
contrast material (KON-trast muh-TEER-ee-ul)
* A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.
core biopsy (... BY-op-see)
* The removal of a tissue sample with a wide needle for examination under a microscope. Also called core needle biopsy.
CT scan (… skan)
* A series of detailed pictures of areas inside the body taken from different angles. The pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography scan, computerized axial tomography scan, and computerized tomography.
cure (kyoor)
* To heal or restore health; a treatment to restore health.
cytogenetics (SY-toh-jeh-NEH-tix)
* The study of chromosomes and chromosomal abnormalities.
diagnosis (DY-ug-NOH-sis)
* The process of identifying a disease, such as cancer, from its signs and symptoms.
diagnostic procedure (DY-ug-NAH-stik proh-SEE-jer)
* A type of test used to help diagnose a disease or condition. Mammograms and colonoscopies are examples of diagnostic procedures. Also called diagnostic test.
diaphragm (DY-uh-fram)
* The thin muscle below the lungs and heart that separates the chest from the abdomen.
diarrhea (dy-uh-REE-uh)
* Frequent and watery bowel movements.
discharge (DIS-charj)
* In medicine, a fluid that comes out of the body. Discharge can be normal or a sign of disease. Discharge also means release of a patient from care.
electron microscope (ee-LEK-tron MY-kroh-SKOPE)
* A microscope (device used to magnify small objects) that uses electrons (instead of light) to produce an enlarged image. An electron microscope shows tiny details better than any other type of microscope.
endoscope (EN-doh-SKOPE)
* A thin, tube-like instrument used to look at tissues inside the body. An endoscope has a light and a lens for viewing and may have a tool to remove tissue.
endoscopy (en-DOS-koh-pee)
* A procedure that uses an endoscope to examine the inside of the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.
enzyme (EN-zime)
* A protein that speeds up chemical reactions in the body.
excisional biopsy (ek-SIH-zhuh-nul BY-op-see)
* A surgical procedure in which an entire lump or suspicious area is removed for diagnosis. The tissue is then examined under a microscope.
fecal occult blood test (FEE-kul uh-KULT...)
* A test to check for blood in the stool. Small samples of stool are placed on special cards and sent to a doctor or laboratory for testing. Blood in the stool may be a sign of colorectal cancer. Also called FOBT.
fever (FEE-ver)
* An increase in body temperature above normal (98.6 degrees F), usually caused by disease.
fine-needle aspiration biopsy (... NEE-dul AS-pih-RAY-shun BY-op-see)
* The removal of tissue or fluid with a thin needle for examination under a microscope. Also called FNA biopsy.
fluid (FLOO-id)
* A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.
gene (jeen)
* The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein.
glucose (GLOO-kose)
* A type of sugar; the chief source of energy for living organisms.
head and neck cancer (... KAN-ser)
* Cancer that arises in the head or neck region (in the nasal cavity, sinuses, lips, mouth, salivary glands, throat, or larynx [voice box]).
hemoglobin (HEE-moh-GLOH-bin)
* The substance inside red blood cells that binds to oxygen in the lungs and carries it to the tissues.
histology (his-TAH-loh-jee)
* The study of tissues and cells under a microscope.
hysterectomy (HIS-teh-REK-toh-mee)
* Surgery to remove the uterus and, sometimes, the cervix. When the uterus and the cervix are removed, it is called a total hysterectomy. When only the uterus is removed, it is called a partial hysterectomy.
immune response (ih-MYOON reh-SPONTS)
* The activity of the immune system against foreign substances (antigens).
immune system (ih-MYOON SIS-tem)
* The complex group of organs and cells that defends the body against infections and other diseases.
immunohistochemistry (IH-myoo-noh-HIS-toh-KEH-mih-stree)
* A technique used to identify specific molecules in different kinds of tissue. The tissue is treated with antibodies that bind the specific molecule. These are made visible under a microscope by using a color reaction, a radioisotope, colloidal gold, or a fluorescent dye. Immunohistochemistry is used to help diagnose diseases, such as cancer, and to detect the presence of microorganisms. It is also used in basic research to understand how cells grow and differentiate (become more specialized).
incision (in-SIH-zhun)
* A cut made in the body to perform surgery.
incisional biopsy (in-SIH-zhuh-nul BY-op-see)
* A surgical procedure in which a portion of a lump or suspicious area is removed for diagnosis. The tissue is then examined under a microscope to check for signs of disease.
infection (in-FEK-shun)
* Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.
injection (in-JEK-shun)
* Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."
laboratory test (LA-bruh-tor-ee...)
* A medical procedure that involves testing a sample of blood, urine, or other substance from the body. Tests can help determine a diagnosis, plan treatment, check to see if treatment is working, or monitor the disease over time.
lens (lenz)
* A clear disk that focuses light, as in a camera or microscope. In the eye, the lens is a clear, curved structure at the front of the eye behind the pupil. It focuses light rays that enter the eye through the pupil, making an image on the retina (light-sensitive layers of nerve tissue at the back of the eye).
liver (LIH-ver)
* A large organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile.
lung
* One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.
lymph node (limf node)
* A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.
malignant (muh-LIG-nunt)
* Cancerous. Malignant cells can invade and destroy nearby tissue and spread to other parts of the body.
mammogram (MA-muh-gram)
* An x-ray of the breast.
metastasis (meh-TAS-tuh-sis)
* The spread of cancer from one part of the body to another. A tumor formed by cells that have spread is called a “metastatic tumor” or a “metastasis.” The metastatic tumor contains cells that are like those in the original (primary) tumor. The plural form of metastasis is metastases (meh-TAS-tuh-SEEZ).
microscope (MY-kroh-SKOPE)
* An instrument that is used to look at cells and other small objects that cannot be seen with the eye alone.
MRI
* A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called magnetic resonance imaging, NMRI, and nuclear magnetic resonance imaging.
NCI
* NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. It conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://www.cancer.gov. Also called National Cancer Institute.
organ (OR-gun)
* A part of the body that performs a specific function. For example, the heart is an organ.
oxygen (OK-sih-jen)
* A colorless, odorless gas. It is needed for animal and plant life. Oxygen that is breathed in enters the blood from the lungs and travels to the tissues.
pancreas (PAN-kree-us)
* A glandular organ located in the abdomen. It makes pancreatic juices, which contain enzymes that aid in digestion, and it produces several hormones, including insulin. The pancreas is surrounded by the stomach, intestines, and other organs.
pathologist (puh-THAH-loh-jist)
* A doctor who identifies diseases by studying cells and tissues under a microscope.
PET scan (… skan)
* A procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body. Also called positron emission tomography scan.
physical examination (FIH-zih-kul eg-ZA-mih-NAY-shun)
* An exam of the body to check for general signs of disease.
platelet (PLATE-let)
* A tiny piece of a cell found in the blood that breaks off from a large cell found in the bone marrow. Platelets help wounds heal and prevent bleeding by forming blood clots. Also called thrombocyte.
primary tumor (PRY-mayr-ee TOO-mer)
* The original tumor.
prognosis (prog-NO-sis)
* The likely outcome or course of a disease; the chance of recovery or recurrence.
prostate-specific antigen (PROS-tayt-speh-SIH-fik AN-tih-jen)
* A protein made by the prostate gland and found in the blood. Prostate-specific antigen blood levels may be higher than normal in men who have prostate cancer, benign prostatic hyperplasia (BPH), or infection or inflammation of the prostate gland. Also called PSA.
protein (PROH-teen)
* A molecule made up of amino acids that are needed for the body to function properly. Proteins are the basis of body structures such as skin and hair and of substances such as enzymes, cytokines, and antibodies.
radioactive (RAY-dee-oh-AK-tiv)
* Giving off radiation.
rectum (REK-tum)
* The last several inches of the large intestine closest to the anus.
recur
* To come back or to return.
red blood cell (red blud sel)
* A cell that carries oxygen to all parts of the body. Also called erythrocyte and RBC.
scanner (SKA-ner)
* In medicine, an instrument that takes pictures of the inside of the body.
stool (stool)
* The material in a bowel movement. Stool is made up of undigested food, bacteria, mucus, and cells from the lining of the intestines. Also called feces.
surgery (SER-juh-ree)
* A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.
symptom (SIMP-tum)
* An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.
tissue (TIH-shoo)
* A group or layer of cells that work together to perform a specific function.
tumor (TOO-mer)
* An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.
tumor marker (TOO-mer ...)
* A substance that may be found in tumor tissue or released from a tumor into the blood or other body fluids. A high level of a tumor marker may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (in ovarian cancer), CA 15-3 (in breast cancer), CEA (in ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (in prostate cancer).
urinalysis (YOOR-ih-NA-lih-sis)
* A test that determines the content of the urine.
urine (YOOR-in)
* Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra.
uterus (YOO-teh-rus)
* The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called womb.
vein (vayn)
* A blood vessel that carries blood to the heart from tissues and organs in the body.
white blood cell (hwite blud sel)
* A type of immune cell. Most white blood cells are made in the bone marrow and are found in the blood and lymph tissue. White blood cells help the body fight infections and other diseases. Granulocytes, monocytes, and lymphocytes are white blood cells. Also called leukocyte and WBC.
x-ray (EX-ray)
* A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.
There is no staging system for carcinoma of unknown primary (CUP).
The extent or spread of cancer is usually described as stages. The stage of the cancer is usually used to plan treatment. However, CUP has already spread to other parts of the body when it is found.
The information that is known about the cancer is used to plan treatment.
Doctors use the following types of information to plan treatment:
* The place in the body where the cancer is found, such as the peritoneum or the cervical (neck), axillary (armpit), or inguinal (groin) lymph nodes.
* The type of cancer cell, such as melanoma.
* Whether the cancer cell is poorly differentiated (looks very different from normal cells when viewed under a microscope).
* The signs and symptoms caused by the cancer.
* The results of tests and procedures.
* Whether the cancer is newly diagnosed or has recurred (come back).
Treatment Option Overview
Key Points for This Section
* There are different types of treatment for patients with carcinoma of unknown primary (CUP).
* Four types of standard treatment are used:
* Surgery
* Radiation therapy
* Chemotherapy
* Hormone therapy
* New types of treatment are being tested in clinical trials.
* Patients may want to think about taking part in a clinical trial.
* Patients can enter clinical trials before, during, or after starting their cancer treatment.
There are different types of treatment for patients with carcinoma of unknown primary (CUP).
Different types of treatment are available for patients with CUP. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Four types of standard treatment are used:
Surgery
Surgery is a common treatment for CUP. A doctor may remove the cancer and some of the healthy tissue around it.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Intensity-modulated radiation therapy (IMRT) is a type of 3-dimensional (3-D) radiation therapy that uses a computer to make pictures of the size and shape of the tumor. Thin beams of radiation of different intensities (strengths) are aimed at the tumor from many angles. This type of radiation therapy is less likely to cause dry mouth, trouble swallowing, and damage to the skin.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of two or more anticancer drugs.
Hormone therapy
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.