Cancer of Unknown Primary (CUP)
This pathway is for those where a likely advanced malignancy has been identified (normally on imaging) but the source of the primary cancer is unknown. Patients with metastatic disease with an established invasive cancer, or where the clinical picture is suggestive of a primary source, should be referred to the relevant specialty.
The pathway requires some baseline investigations to be done prior to referral – please see Primary Care Management for full details.
This pathway is intended to:
- improve the pathway to diagnosis for patients who present de novo with advanced malignancy without an obvious primary site – a Malignancy of Undefined Primary Origin (MUO)
- enable early identification of patients who would benefit from anti-cancer treatment
- prevent unnecessary investigations in those patients who are unfit for treatment or do not wish further investigation.
The Clinical Team.
The team is based at the Western General Hospital. Please note that the contact details below are for use by clinicians only:
Medical
Dr Sally Clive (Consultant Medical Oncologists) 0131 537 2263
Dr Colin Barrie (Consultant Medical Oncologists) 0131 537 3097
Dr Marj McLennan (Consultant Clinical Oncologist – radiotherapy) 0131 537 1036
Nursing
Gillian Knowles (Nurse Consultant) 0131 537 3793
Rachel Haigh (Clinical Nurse Specialist) 0131 537 1341
The clinical team will:
- Provide Multidisciplinary Team (MDT) review of radiological imaging +/- pathology of patients with suspected CUP. MDT meetings are held first thing on Monday mornings
- Provide advice regarding management of patients with suspected Malignancy of Undefined Primary Origin
- Discuss patients out-with the multidisciplinary meeting where that is requested
- See patients urgently in CUP oncology clinics (Wed and Thurs) to assess and arrange further selected investigations as is clinically appropriate
- Contact patients by phone and provide support and communication throughout the diagnostic workup
- Refer to site-specific cancer MDTs and oncologists/haematologists if a primary cancer site is found after further targeted investigation
- Facilitate diagnostic work-up without the need for hospital admission
- Discharge back to GP if a benign diagnosis is confirmed by the MDT.
Prior to referral, please ensure patient is informed of suspicion of cancer, is aware of referral to the CUP team, and knows to expect a phone call from cancer nurses. Please also complete the assessments outlined in the Primary Care Management guidance.
