• Looking for any information on Cancer of Unknown Primary.

    Asked by seesun87 on Thursday, January 10, 2013

    Looking for any information on Cancer of Unknown Primary.

    I am interested in any feedback on Cancer of Unknown Primary. I am having a hard time understanding how they do not have a definitive answer on where the cancer started. A biospy of a swollen lymphnode in my neck is showing most likley cause colon cancer. My PET scan nor colonoscopy showed anything. This all started in October with swollen lymphnodes on the right side of my neck. Was being treated with antibiotics for possible tooth problem, did not get any better after a few rounds of antibiotics. I when for a chest x-ray December 3rd, found something on lung, did Cat-scan confirmed spot in center portion of chest between lungs. At first they thought I had Lymphoma, after biospy confirmed it did not start in the lungs and it is not Lymphoma. I am being treated with very strong chemo drugs that work on a wide variety of cancers. She (my oncologist) feels it started in the colon based on biopsy results and turmor markers. This is all very confusing to me.

    7 Answers from the Community

    7 answers
    • nancyjac's Avatar

      What is it you are confused about? It sounds like you have a very good handle on what CUP is. Cancer can begin in any organ or tissue of the body. The primary, or original, tumor is usually named for the part of the body or the type of tissue in which the cancer begins. The disease may spread (metastasize) from the primary tumor and form metastatic tumors in other parts of the body. For example, breast cancer cells can metastasize to the lungs and cause the growth of a new tumor. When this happens, the tumor in the lung is called metastatic breast cancer because the breast cancer cells have traveled via the lymphatic or circulatory systems to the lung.

      However, when the primary (i.e. original) site of the cancer cannot be identified, cancer of unknown primary (CUP) is the resulting diagnosis. Most often, the metastatic cancer is first found in the lymph nodes, liver, lung, or bone.

      In any case, treatment depends on where the cancer is found, the microscopic appearance of the cancer cells, the biochemical characterization of the cells and the patient’s age and overall physical condition. No method is standard, but chemotherapy, radiation therapy, hormone therapy, and surgery may be used alone or in combination to treat patients who have CUP, just as would be the case for those with cancer with an identified primary location.

      almost 4 years ago
    • GregP_WN's Avatar

      Hi Seesun, here is the link to our own page that has a little information on it, and there should be some people on the bottom of the page with experience.

      Take a look at that and see if there is anything there that will help you. Others will probably come along and offer help also.

      almost 4 years ago
    • Harry's Avatar

      I think I can understand the confusion. They "ought" to know--but they don't. In this modern age of medicine surely they can tell. Well, I guess it isn't that easy. They do the tests, and decide what it looks like, but in this case it appears to be difficult to distiguish between possibilities. And, yes, I've heard of cases where the "origin" seems cancer free and only the mets show up.

      almost 4 years ago
    • Carol-Charlie's Avatar

      Me too Harry. I've a few friends diagnosed CUP. Seesun, if you trust your doctor just keep doing what they ask of you. I put my hand in God's and asked Him to lead me where he wanted me to be. I'm here Cancer Free now for 7 years. God bless you!.

      almost 4 years ago
    • carm's Avatar

      Hello seesun87, I am an oncology/end of life nurse and a diagnosis of cancer of unknown primary can seem pretty confusing, but this disgnosis is more common than you know. If a pathologist is confident of a cancer but cannot differentiate a general category of these abnormal growths called neoplasms (i.e; carcinoma, lymphoma, melanoma, sarcoma, etc) then this tumor is designated as a poorly differentiated neoplasm which means that under microscopic examination, the cells look much like normal cells so you can barely tell the difference between these cells and normal cells. Normally, to try and establish the type of cell or the cells origin, they can use a couple of diagnostic tools. One is called Immunoperoxidase Tumor Staining which can help classify the cells. Sometimes Electron Microscopy is used; however it is costly and so not widely available. Also Genetic Analysis helps determine some cancers because chromosomal abnormalities have been well characterized in several hematopoietic (cells formed in blood) cancers like Non Hodgkins Lymphoma. If your oncologist feels that the origin is the colon based on a biopsy, it is possible that through staining that biopsy they found certain antigens or proteins. For example, in a normal staining to establish a primary, there are an assortment of cytokeratins; these are proteins found in the tissues. Some are neutral or basic, and some are more acidic. They number CK 1 through CK 20. To come to a conclusion that the probable origin could be the colon; the staining might reveal CK 7 (-) and CK 20 (+). CK 7 is usually expressed in the ductal epithelium (cells that cover the surface of an organ) of the genitourinary tract and it is considered a neutral or or basic cytokeratin. CK 20 is most common in the gastrointestinal tract and it is more acidic. When using Electron Microscopy; in the broad category of cancers of unknown primary site, there are 5 major light microscopic diagnoses: (i) poorly differntiated neoplasm, (ii) poorly differntiated carcinoma (with or without the features of adenocarcinoma), (iii) well-differentiated and moderately well-differentiated adenocarcinoma, (iv) squamous cell carcinoma and (v) neuroendocrine carcinoma. I understand how it can be confusing. Looking at tissues under a microscope, many have characteristics unlike any other and we know by looking at them where they stem from or the type they are. However, sometimes they look so similar to other cells, it is hard to determine where they originate. It makes it hard to establish but not hard to treat. With the advance of chemotherapies, using combination therapy and targeted therapies, there are so many weapons in the arsenal that can trigger a response to this diagnosis. I hope this helps, Carm.

      almost 4 years ago
    • SueRae1's Avatar

      My friend's mother was diagnosed with advanced breast cancer, but a primary tumor was never found mammograms and exams never. found anything amiss either breast. cancer is a tricky devil and the more we learn about it. the more we realize how much we still don't understand about its cause or how it spreads.

      almost 4 years ago
    • packerbacker's Avatar

      I can totally relate. I had a CT scan of my chest for chest pain which revealed some enlarged lymph nodes. Biopsies were inconclusive. Another biopsy of the lung again did not reveal anything definitive. A few months later, I had left sided ear and jaw pain, which revealed tongue cancer. Follow-up showed a new lung lesion, findings too undifferentiated to determine primary cancer. After treatment, 6 more lesions showed up. Biopsy of a lymph node shows a sarcomoid variant of head and neck cancer. I still don't have a primary site but will be starting my third different set of chemo drugs next week. I am confused also, but they are leaning toward some form of head and neck cancer, I think. As the cancer gets further along and spreads to other sites, the cells look less like they did than where it first started. So, a primary site can be difficult. I hope this helps you see that you are not alone!! It's frustrating, but keep communicating with your doc. Best of luck to you!

      almost 4 years ago

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