Objectives
  • To be able to recognise carcinoma of unknown primary site (CUP) subsets (favourable vs unfavourable) and to treat them accordingly

Awareness
  • Awareness that CUP is not a rare malignant disorder; it accounts for 3–5% of all human cancers and is the fourth most common cause of cancer death

  • Awareness that CUP incidence is declining due to improved diagnostic approaches

  • Awareness of the diagnostic methods to identify the primary sites, including pathology/molecular pathology, imaging and endoscopies

  • Awareness that CUP is not a single disease

  • Awareness that CUP is divided to favourable (20%) and unfavourable subsets (80%)

  • Appreciation that the most common histological type is well to poorly differentiated adenocarcinoma, followed by squamous cell and undifferentiated neoplasms

  • Awareness that gene profiling technology identifies 90% of primary tumours

Knowledge
  • Knowledge of how to interpret immunohistochemistry (IHC)

  • Knowledge that the routine use of serum epithelial tumour markers has no diagnostic, prognostic or predictive value

  • Knowledge that positron emission tomography (PET) scan technology has higher sensitivity to detect mainly hidden primary head and neck or lung cancers

  • Understanding that endoscopies should be ordered only in patients with relevant symptoms or signs

  • Knowledge that favourable CUP subsets should be treated with curative intent, and unfavourable subsets with palliative intent

  • Knowledge that data from phase III prospective randomised studies, justifying the use of gene profiling technology for treating CUP patients with specifically directed treatment, are not available yet

  • Knowledge that data on the use of targeted treatments in CUP patients are still anecdotal

Skills
  • Ability to suspect, diagnose and classify CUP patients

  • Ability to recognise and treat favourable subsets similarly to the relevant primary tumours, ie, the subset of axillary lymphadenopathy as breast cancer, the subset of serous peritoneal adenocarcinoma as ovarian cancer or the subset of squamous cell carcinoma of the cervical nodes as head and neck cancer

  • Ability to request gene profiling testing for the right patient, ie, young patients, patients with poorly differentiated or undifferentiated carcinomas, potentially chemo-sensitive tumours, etc

  • Ability to recognise that unfavourable CUP patients carry, in general, an aggressive course with poor prognosis

  • Ability to contribute in multidisciplinary teams where medical oncologists, radiation oncologists, surgeons, pathologists, radiologists, special nurses and psychologists are participating