How is CUP treated?

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Treatment of CUP:

Cancer of unknown primary may involve various other types of unidentified cancer; therefore, creating reasonable treatments can be very difficult. You are unlikely to get a breakthrough with a single treatment method. It has been found, however, that some CUP patients may benefit from treatment targeted at types of cancer whose primary sites are known (known cancer types). The effectiveness of the treatment may be dependent on the accuracy of the specific cancer classification.

Cancer cells are sometimes tested from the laboratory to establish which treatment method and medication may be safe and effective, to use. Most of the patients affected with types of cancer of unknown primary may sometimes find it inevitable to seek further testing. If progress is to be achieved, clinical trials are deemed as a necessity. The clinical trials may be designed to test new chemotherapy drugs, new medical combination formulas or even new ways of administering drugs.

Also, some clinical trials are meant to study new approaches to cancer of unknown primary treatment. These approaches may include:

Biological therapy

Immunotherapy

Gene therapy

Chemotherapy

Advanced Physiotherapy

1.Chemotherapy

This method is popularly known as chemo.’

Chemo uses anti-cancer medicines that are normally administered through an intervening drip, or orally. Through the circulation system, the anti-cancer medicines can reach all parts of the body and therefore, reach the cancerous cells. For carcinoma of unknown primary, chemotherapy is considered to be the most effective treatment since it can cure cancer that affects areas that are not detected.

Depending on CUP circumstances, chemotherapy may be designed so as to achieve various objectives.

When staging is advanced (during later stages: stages three and4), CUP can be effectively treated using chemotherapy because surgery and radiation therapy may be unsuitable, especially in cases where the extent of the metastasis of the cancer is unknown.

Chemotherapy is normally combined with other cancer treatments such as surgery and radiation therapy so as to increase effectiveness. On an average, radiation and surgery do not remove cancer up to 100 per cent. The traces of remaining cancer can be destroyed by the use of chemo drugs.

Chemotherapy formulas may involve a combination of drugs for effectiveness in cancer treatment. For a cancer patient’s information, the following are some of the possible drug combinations:

For treating poorly differentiated carcinomas, a platinum drug may be used together with a Taxane drug. This formula may also be applied to adenocarcinomas.

For squamous cell cancer, your doctor may prescribe a combination of Cisplatin, 5-flourouracil (5-FU) and Taxane.

Poorly differentiated neuroendocrine carcinomas will make use ofEtoposide and platinum medicine to treat the carcinoma.

2.Targeted Therapy for CUP

With the advancements in cancer treatment technology, a more recent cancer treatment called targeted therapy uses drugs and other substances to destroy the cancerous cells while preserving other normal cells. Ultimately, targeted therapy is aimed at altering the way a cancerous cell grows, divides, and associates with other normal healthy cells.

There are Different Types of Targeted Therapy:

Epidermal growth factor receptor (EGFR), which is a targeted therapy drug, meant to treat squamous cell cancer of the head and neck. This cancer type is known to metastasize more rapidly and is, therefore, resistant to cancer treatment methods such as radiation and chemotherapy. Cetuximab is a targeted therapy drug, used to block the EFGR and can be helpful to those who have squamous cell cancer in the head or neck. This type of targeted therapy medicine is considered as an alternative to chemotherapy and radiation treatment methods in cases where the doctor foresee adverse side effects delivered from the use of such treatment methods. However, this type of targeted therapy can be used alongside chemotherapy and radiation.

Trastuzumab is another major type of targeted therapy drug used to treat breast cancer. Trastuzumab is also commonly known as Herceptin. More often, this drug may be used together with chemotherapy, but it can also be used on its own, as a sufficient alternative.

There are many other targeted therapy medicines that can be used in types of cancer where a primary site is identified in the body. Targeted therapy may also be considered useful in the treatment of carcinoma of the unknown primary if examining signs and symptoms as well as conducting tests give a hint as to where the primary site may be located.

3.Hormone Therapy for CUP

Many hormones are present in our body, which naturally control the growth and other activities of cells. Cancer cells have hormone receptors and these naturally occurring hormones in our body attach to these receptors helping cancer cells to grow. With hormone therapy, these receptors can be blocked, thus reducing the hormone effect on the cancer cells. Some cancer types such as breast and prostate cancer are associated with reproductive sex hormones. Sex hormones catalyze (speed up) the spread of these types of cancer.

Hormone therapy is carried out to contain the growth of cancer types if doctors suspect that cancer of unknown primary has its primary site in these areas (breast and testicles).Hormone therapy may involve the use of drugs. For instance, in cases of breast cancer, Tamoxifen and Aromatase inhibitors may be used to either decrease the estrogen levels or prevent cancer cells from being able to use them.

While in the development of prostate cancer, anti-cancer medicines such as Flutamide and Bicalutamide are used to lower testosterone levels or prevent cancer cells from using it.

Surgical removal of the testicles or the breast may also be considered an option, in cases where the administration of medication or other types of treatment is deemed ineffective. This is the last resort for cancer patients and should be considered thoroughly, as it may eliminate the cancerous cells, and offer the patient a long, natural life when relapse does not occur.

Follow Ups

It is important to attend follow-up appointments. Such strategy is meant to closely monitor how a patient is recovering and the response to specific cancer treatment options. Follow ups may include physical examinations and other tests.

All patients, whether they were successful in the treatment of their CUP or not, are advised to have a follow-up care plan. The plan may differ from patient to patient depending on the situations of the CUP treatment methods and their responses.

Also, similar or different treatment methods may have different side effects. Thus it may help to study these side effects and appropriately design a follow-up strategy.

Immediately after the conclusion of treatment is made, close follow-ups are recommended with regular physiotherapies and repeated lab tests. X-rays and scans may also be undertaken during the follow-up sessions. During this follow-up, the patient should report any new symptoms that are appearing in his or her body even if they are not resulting from treatment of cancer, and seem to be of minor importance.

It is during the follow-ups that a CUP patient is regularly advised which lifestyle to adopt. This may include ways of maintaining good health, as well as environmental conditions which should be avoided if such may trigger reoccurrence or development of cancer.

Follow ups may also help a carcinoma of an unknown primary cancer patient to come to terms with his or her new situation in life.

Recurrent Carcinoma of Unknown Primary

When the CUP appears after the treatment, it is called recurrent carcinoma of unknown primary. The treatment option for recurrent carcinoma of unknown primary includes, quite often, a clinical trial. Treatment depends on the cancer type; the way cancer was treated before if cancer has come back and the condition of the patient.


Dr. Adem Gunes
Dr. Abdullah El-Hossami

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