Cancer can spread from where it started to other parts of the body. Cancer that has spread to other parts of the body is called metastases, or mets. For example, breast cancer can spread to the bones. It is important to know the type of cancer that has spread so it can be treated effectively.

Each year in the US, in about 70,000 cancer patients, the disease is found when it has already spread to one or more sites and doctors are not sure where it started¹. This type of cancer is called cancer of unknown primary, or CUP¹.

CUP has always spread beyond the place where it started by the time it is found. If it had been found early, it would not be CUP.

In an attempt to find the place where the cancer started, called the primary origin, the doctor will first take a medical history and do a physical exam. Sometimes these basic steps can suggest the source of the cancer. If not, other tests such as imaging scans and blood tests may help narrow the search. However, it is important to keep in mind that you are not guaranteed a specific diagnosis by taking these tests.

It is in your best interest to find out which test(s) your doctor plans to use to diagnose your cancer. A new kind of test called miRview™ mets may be able to help your doctor determine where your cancer started, regardless of whether or not you have been officially diagnosed as a CUP patient. This is important because the origin of your cancer has a big impact on your treatment plan. If your doctor is not familiar with miRview™ mets, click on the button above to print out information to bring to your next appointment.

CUP is difficult to treat because the primary tumor site is not known. The types of treatment that may be used for CUP include surgery, radiation, chemotherapy, and hormone therapy².

As you cope with cancer and cancer management, be sure to have open, honest discussions with your doctor. You should feel free to ask any questions on your mind. Below are some questions you might want to ask. Be sure to add your own questions as you think of them.

• What tests have you done on my biopsy samples?
• Will you do any microRNA testing?
• How much testing should I have to find out what kind of cancer I have?
• What treatment choices do I have?
• Which treatment do you recommend and why?
• How long will treatment last? What will it involve? Where will it be done?
• What side effects are there to the treatment you recommend?
• What can I do to cope with the side effects?
• Are there any clinical trials I should think about taking part in?

1. Overview: cancer of unknown primary: what is cancer of unknown primary? American Cancer Society Web site. Updated November 30, 2008. Accessed February 25, 2009.
2. Overview: cancer of unknown primary: how is cancer of unknown primary treated? American Cancer Society Web site. Updated November 30, 2008. Accessed February 25, 2009.