Abstract
BackgroundIn the United Kingdom, national guidance published in 2010 recommended the establishment of specialist teams to improve clinical pathways for patients presenting with malignancies of undefined primary origin (MUO) and cancer of unknown primary (CUP). This study sought to define outcomes of patients referred to a regional MUO/CUP service.MethodsData were collected prospectively on all patients (n = 1225) referred to a regional CUP team over a 10-year period. Patient demographics, clinical, pathological and outcome data were recorded and analysed.ResultsConfirmed CUP (cCUP) was diagnosed in 25% of patients. A primary metastatic cancer was identified in 36%, 5% were diagnosed with provisional CUP (pCUP), 27% retained the diagnosis of MUO and in 8% a non-cancer diagnosis was made. Median survival was low in all patients with a final malignant diagnosis: primary identified 9.0 months, cCUP 4.0 months, pCUP 1.5 months and MUO 1.5 months.ConclusionsPatients presenting with MUO have poor outcomes irrespective of the final diagnosis. These patients need a patient-centred, streamlined, rapid diagnostic pathway. There are clear benefits to primary and secondary care teams having access to a dedicated, multidisciplinary MUO/CUP service, with clinical nurse specialists supporting the patients, to help facilitate this pathway and ensure early oncology review.
Highlights
Patients presenting with a metastatic malignancy identified on clinical or radiological examination without an obvious primary site are said to have a malignancy of undefined primary origin (MUO) [1,2,3]
cancer of unknown primary (CUP) may be defined further into provisional CUP or confirmed CUP dependent on the extent of investigation and whether the patient has been reviewed by an oncologist with a specialist interest in CUP [2]
We present the largest prospectively recorded and evaluated cohort of patients referred to an MUO/CUP service in the United Kingdom (UK)
Summary
Patients presenting with a metastatic malignancy identified on clinical or radiological examination without an obvious primary site are said to have a malignancy of undefined primary origin (MUO) [1,2,3]. CUPs may be defined further into provisional CUP (pCUP) or confirmed CUP (cCUP) dependent on the extent of investigation and whether the patient has been reviewed by an oncologist with a specialist interest in CUP [2] Whilst this terminology is well recognised by those working in acute oncology and CUP teams, it is less well known by nonspecialist teams, and the diagnosis of ‘CUP’ can be used somewhat indiscriminately. CUP represents ~2% of all new cancer diagnoses in the UK, and despite being only the 15th most common cancer by incidence, it is the 6th most common cause of cancer death [5]
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