Carcinoma of Unknown Primary Health Article

Clinical trials

Research regarding the nature and treatment of cancer of unknown primary is being conducted in several areas. New chemotherapy drugs, drug combinations, methods of administering chemotherapy, and the effect of peripheral stem cell transplantation on CUP are currently under study. In addition, gene therapy is also being tested as a treatment for CUP. Other approaches under examination include sensitizing the body's immunologic T-cells against cancer cells, as well as using vaccines. Since CUP is a term for several different types of cancer, an improved overall understanding of cancer can help the medical community create improved treatments. One of the ways this happens is through participation in clinical trials. The patient with cancer of unknown primary can find out what clinical trials are available by contacting the National Cancer Institute.

Prevention

Since the exact type of cancer involved in CUP is not known, it is difficult to say just how that cancer might have been prevented, if at all. The risk factors are difficult to identify. Autopsy studies, however, can be of assistance. Patients who have died of CUP show that many of the cancers began in the pancreas, lungs, kidneys, throat, larynx, or esophagus. Smoking is a significant risk factor for each of these cancers.

Other sites of CUP include the stomach, colon, or rectum. High-fat dietary habits are linked to these cancers. Fresh fruits, vegetables and high-fiber foods offer the greatest dietary protection. Another source of CUP is a type of skin cancer termed malignant melanoma. Its primary risk factor is unprotected exposure to the sun.

Special concerns

The inability to identify a primary site for metastatic cancer can generate a great deal of anxiety, anger and frustration for patients and family. They may believe that the physician is incompetent or that the prognosis would be improved if a primary site could be definitively identified. Though it is important to do necessary diagnostic testing, it is common for patients and families to encourage a physician to keep testing well beyond the point in which the primary tumor is likely to be discovered. At this stage, the presence of metastatic tumors indicates that the cancer has already spread, and it is important to start treatment as soon as possible.

Resources

BOOKS

Buckman, Robert, Dr. What You Really Need to Know About Cancer: A Comprehensive Guide for Patients and Their Families. Baltimore: Johns Hopkins University Press, 1997.

PERIODICALS

Cassileth, Barrie R. "Evaluating Complementary and Alternative Therapies for Cancer Patients." CA: A Cancer Journal for Clinicians (November/December 1999): 353-61.

Ward, Darrell. "The Case of the Missing Primary." Frontiers(Spring/Summer 1999): available at <http://www.osu.edu/units/cancer/frontier.htm>.

ORGANIZATIONS

American Cancer Society. (800)ACS-2345. <http://www.cancer.org>.

National Cancer Institute. Building 31, Room 10A31, 31 Center Drive, MSC 2580, Bethesda, MD 20892-2580. (800) 4-CANCER. <http://www.nci.nih.gov>.

OTHER

National Coalition for Cancer Survivorship 8 June 2001 <http://www.cansearch.org>.

Deanna Swartout-Corbeil, R.N.

Chemotherapy

—The treatment of disease by means of chemicals that have a specific toxic effect on the disease-producing microorganisms or that selectively destroy cancerous tissue.

Metastasis

—The process in which cancer cells travel or spread from their original site to other parts of the body.

Primary site

—The area in the body where a cancer originates.

QUESTIONS TO ASK THE DOCTOR

• What treatment choices do I have? Which do you recommend, and why?
• What side effects from treatment can I expect, and what can I do to help reduce them?
• What are the chances that my CUP will return once I am in remission?