MUO / CUP

Question 1

Define Malignancy of Unknown Origin (MUO)

Answer 1

Covers any suspected cancer

A limited number of tests

Question 2

Define Carcinoma of Unkown Primary (CUP)

Answer 2

Epithelial or neuroendocrine cancer. the primary site is unknown despite specialist investigations

(lymphoma, sarcoma, melanoma, germ cells)

e.g old person scanned- lots of mets on cxr. not going to biopsy etc.

Question 3

what are the essential investigations for suspected cancer?

Answer 3

a careful and thorough examination
blood
tumour markers
CXR
CT TAP (thorax, abdomen, pelvis) *on the same day as CXR
consider endoscopy according to symptoms

Question 4

what are the essential investigations for suspected cancer?

Answer 4

a careful and thorough examination
blood
tumour markers
CXR
CT TAP (thorax, abdomen, pelvis) *on the same day as
FNA (lumps)
PET (lumps)
consider endoscopy according to symptoms

Question 5

mottled shadowing on CXR

Answer 5

mottled shadowing- can be malignancy/scarring from measles

multiple nodules on CT

Question 6

investigations for suspected malignancy

Answer 6

biopsy to histopathologists
when cancer metastasis it retains some of the characteristics where it came from.

sometimes immunohistochemistry biopsy can be unhelpful as the cancer is very poorly differentiated it’s lost all features of primary site = CUP.

Question 7

treatment for cancer

Answer 7

MDT referral
palliative treatment
CNS and specialist palliative care team referral
systemic chemotherapy/radiotherapy

Question 8

skin metastases

Answer 8

inflammatory breast cancer

metastates of melanoma

Question 9

drainage of lymph nodes

superficial inguinal lymph nodes

Answer 9

drains from the skin on legs, skin area around perineum, penis and foreskin, the lower part of the bowel.

Question 10

isolated squamous cell carcinoma

Answer 10

isolated can be curative
e.g lump in brain, axilla, liver, lung, bone, groin

never found out where it has come from

the radiotherapy / chemo co could have treated the 1’ when treating the 2’

or the immune system may have cleared the 1’ but couldn’t 2’

Question 11

what is an ECOG performance

Answer 11

briefly describes a patient’s fitness

0= unrestricted
1= some restriction
2= fully self-caring, less than 50% of the day in a chair
3= limited self-care. bed or chair >50% day
4= ?
5= dead