Refer patients with a suspected cancer of unknown primary (CUP) if they present with symptoms or signs suggestive of malignancy that warrant urgent investigation, such as unexplained lymphadenopathy, unexplained weight loss, or systemic symptoms consistent with cancer NICE CG104.
Patients should be referred for further assessment if initial investigations, including history, physical examination, blood tests, and imaging, do not identify a primary site but raise suspicion of metastatic malignancy NICE CG104.
Specifically, referral is recommended when there are clinical features suggestive of metastatic epithelial or neuro-endocrine malignancy without an identifiable primary after initial tests, or if special investigations (e.g., PET-CT, immunohistochemistry) are indicated to locate the primary NICE CG104.
In cases where initial investigations suggest a specific treatable syndrome, referral should be made accordingly, but if no primary is identified, suspicion of CUP remains, and specialist assessment is warranted NICE CG104.
Key References
- CG104 - Metastatic malignant disease of unknown primary origin in adults: diagnosis and management
- CKS - Breast cancer - recognition and referral
- CKS - Lung and pleural cancers - recognition and referral
- CKS - Haematological cancers - recognition and referral
- CKS - Central nervous system and brain cancers - recognition and referral