Clinical Case Database / Category: Case Based Discussion

Metastatic carcinoma of unknown primary

Publication details

Dr Daniel Krell MRCP, BSc
Foundation Years Journal, volume 4, issue 4, p.20 (123Doc Education, London, April 2010)


Metastatic carcinoma of unknown primary (CUP) accounts for 2–4% of all malignancies. Patients present with metastatic disease, but despite standard investigations, the primary site often cannot be located. The prognosis is poor, except in a few specific subgroups, and response to chemotherapy remains disappointing. Patients often initially present with symptoms of metastatic cancer to their GP or A&E and are admitted to hospital under acute medical or surgical teams for investigation, before being referred to oncology services for treatment once a diagnosis has been made. This case-based discussion illustrates a typical case of a patient who presents with CUP and outlines the process by which the patient should be investigated, and referred to the oncology services. The importance of involving multidisciplinary team members is highlighted and the process of breaking bad news is discussed. The use of novel molecular diagnostic techniques is also described.

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Dr Daniel Krell MRCP, BSc

Specialist Registrar in Oncology in Royal Free Hospital London
Academic Department of Oncology
Royal Free Hospital
Pond Street


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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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