Imaging in cancer of unknown primary
Cancer of unknown primary (CUP) is an oncological diagnosis encompassing whole body disease sites. The term is used in the context of histologically confirmed epithelial malignancy where comprehensive clinical, radiological and pathological investigations fail to identify the organ of origin. CUP accounts for 1-2% of cancers worldwide with 8,100 new cases per year in the UK (2017-19), but poses unique challenges to clinicians due to patients’ atypical presentations, often advanced disease at diagnosis, clinical absence of a primary tumour, and need for enhanced expert histopathological assessment. Robust referral systems to a CUP multidisciplinary team (MDT) comprising oncologists, radiologists, histopathologists, specialist nurses and palliative care is essential to managing these patients who experience significant distress due to diagnostic uncertainty and in whom prognosis of a confirmed CUP is poor, with two-year survival rates less than 30%. Sound, holistic radiological interpretation to include pattern recognition of metastatic disease and suggestion of a potential site for biopsy supports clinicians streamlining management for patients undergoing workup of CUP. An understanding of the subsets of CUP supports the radiologist to guide clinical management.
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