Cancerous Lungs (Two)

Carcinomas, are cancers of the Epithelial tissue, and 
Adenocarcinomas, are cancers of the Glandular Epithelelial cells. Since Epithelelial tissue covers the surface of the body, and lines the internal cavities, Carcinomas include cancer of the skin, breast, liver, pancreas, intestines, lung, prostate, and Thyroid Gland. These cancers, may be spread to other body parts by the Lymphatic System.

Description of Carcinoma Of Unknown Primary

Carcinoma of Unknown Primary (CUP) is a disease in which cancer (Malignant) cells are found somewhere in the body, but the place where they first started growing (the Origin or Primary site) cannot be found. This occurs in about 2%-9% of cancer patients.

Actually, CUP can be described as a group of different types of cancer, all of which become known by the place or places in the body, where the cancer has spread (Metastasized) from another part of the body. Since all of these diseases are not alike, chance of recovery (Prognosis) and choice of treatment, may be different for each patient.

If CUP is suspected, your doctor will order several tests, one of which may be a Biopsy. This means a small piece of tissue is cut from the tumor, and looked at under a microscope. Your doctor may also do a complete history and physical examination, and order chest x-rays along with blood, urine, and stool tests. A cancer can be called CUP, when your doctor cannot tell from the test results where the cancer began.

The pattern of how CUP has spread, may also give the doctor information to help determine where it started. For example, Lung Metastases, are more common when cancer begins above the diaphragm, (the thin muscle under the lungs that helps you breathe). Most large studies, have shown that CUP often starts in the lungs or pancreas. Less often, it may start in the colon, rectum, breast, or prostate.

An important part of trying to find out where the cancer started is, to see how the cancer cells look under a microscope (Histology). Other special tests may also be done that help the doctor find out where the cancer started, and choose the best type of treatment.

Stages Of Carcinoma Of Unknown Primary

When cancer is diagnosed, more tests are usually done to find out if cancer cells have spread to other parts of the body. This is called, Staging. When CUP is diagnosed, the number and type of tests done may be different for each patient. The treatment options in this statement, are based on whether the cancer has just been found, (newly diagnosed) or the cancer has come back after it has been treated. (recurrent)

The treatment options are also based on where the cancer is found, or what it looks like. Your doctor may find that your cancer fits into one of the following groups:

Cancer in the Cervical Lymph Nodes:
Cancer in the small, bean-shaped organs, that make and store infection-fighting cells (lymph nodes) in the neck area.

Poorly differentiated carcinomas:
The cancer cells look very different from normal cells.

Metastatic Melanoma to a single nodal site:
Cancer of the cells that  color the skin (Melanocytes) that has spread to
lymph nodes, in only one part of the body.

Isolated Axillary Metastasis:
Cancer that has spread only to Lymph Nodes in the area of the armpits.

Inguinal Node Metastasis:
Cancer that has spread to Lymph Nodes in the groin area.

Multiple involvement:
Cancer that has spread to several different areas of the body.

How Carcinoma Of Unknown Primary Is Treated

Many different treatments are used either alone or in combination to treat CUP. Some of the treatments, an operation, Radiation Therapy (using high-dose x-rays to kill cancer cells), Chemotherapy (using drugs to kill cancer cells) Hormone Therapy (using hormones to stop the cancer cells from growing).

Surgery is a common treatment for CUP. Your doctor may remove the cancer and some of the healthy tissue around it. Different operations are used depending on where the cancer is found. If the cancer has spread to Lymph Nodes, the Lymph Nodes may be removed (Lymph Node Dissection). If the nodes involved are in the groin, this operation is called a Superficial Groin Dissection. If the cancer has spread to Lymph Nodes and also to some surrounding areas, your doctor may have to remove a larger portion of tissue around the nodes. When muscles, nerves, and other tissue in the neck are removed, this is called a Radical Neck Dissection.

Radiation Therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation may be used alone or before or after surgery.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by mouth in pill form, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a Systemic Treatment, because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body. Chemotherapy may be used alone or after surgery. Therapy given after an operation when there are no cancer cells, that can be seen, is called Adjuvant Therapy.

Hormone Therapy is used to stop the hormones in the body that help cancer cells grow. This may be done by using drugs that change the way hormones work, or by surgery that takes out organs that make hormones, such as the testicles (Orchiectomy).

Treatment By Stage

Treatment for CUP depends on where the doctor thinks the cancer started, what the cancer cells look like under a microscope, and other factors. Surgery and tests may be done to find where the cancer started.

You may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to go into aClinical Trial. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, Clinical Trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical Trials are going on in most parts of the country for CUP.
If you want more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


If the cancer is in the neck area (Cervical Lymph Nodes), your treatment may be one of the following:
1. Surgery to remove the tonsils (Tonsillectomy).
2. Radiation Therapy.
3. Radiation Therapy followed by surgery.
4. Neck surgery (Radical Neck Dissection).
5. Neck surgery followed by Radiation Therapy.
More information is available in the PDQ patient information statement for Metastatic Squamous Neck Cancer with Occult Primary.

If the cancer is a Poorly Differentiated Carcinoma (the cancer cells look very different than normal cells), your treatment will probably be Chemotherapy. Surgery or Radiotherapy has also been used for patients with Neuroendocrine (Nervous System and Hormonal System) cancer.

If the cancer is an isolated axillary nodal metastasis, it is likely that the cancer started in the lung or breast. If you are female, you will have a mammogram (an x-ray picture of the breast) to check for breast cancer. After tests to check for lung and breast cancer, your treatment may be one of the following:
1.Surgery to remove the Lymph Nodes with or without surgery to remove the breast (Mastectomy), or Radiation Therapy to the breast.
2. Treatment as described above, plus, Chemotherapy that is used for Breast Cancer.

If the cancer is in the Inguinal Nodes, your treatment may be one of the following:
1. Surgery to remove the cancer.
2. Groin surgery (Superficial Groin Dissection).
3. Surgery to remove some of the tumor (Biopsy) with or without Radiation Therapy, surgery to remove the Lymph Nodes, or Chemotherapy.

If the cancer is Melanoma, and has spread to a single Nodal site, your treatment will probably be surgery, to remove the Lymph Nodes.

If there is cancer in several different areas of the body, and the doctor thinks that the origin of the cancer is one for which there is Standard Systemic Therapy, then that therapy should be given. The following are examples:
1. Hormone Therapy for, Prostate Cancer.
2. Chemotherapy or Hormone Therapy, for Breast Cancer.
3. Chemotherapy, for Ovarian Cancer.

If the source of the cancer cannot be found, then the best treatment may not be known. You may want to consider taking part in a Clinical Trial.


Treatment for recurrent CUP, depends on the type of cancer, what treatment was received before the part of the body where the cancer has come back, and other factors.

Sarcomas, are cancers that arise in the connective tissues, such as the muscle, bone and Fibrous Conneive Tissue. These cancers may be spread to other body parts by the blood stream.

Lymphomas, are cancers of the Lymphoid System.

More pictures of Lung Cancer

This is the microscopic pattern of a small cell anaplastic (oat cell) carcinoma, in which small dark blue cells with minimal cytoplasm are packed together in sheets.

Multiple variably-sized masses are seen in all lung fields. These tan-white nodules are characteristic for metastatic carcinoma. Metastases to the lungs are more common even than primary lung neoplasms simply because so many other primary tumors can metastasize to the lungs. Even the hilar nodes in this photograph demonstrate nodules of metastatic carcinoma. The nodules are usually in the periphery and do not cause major obstruction.

Here are larger, but still variably-sized nodules,
of metastatic carcinoma in lung.

This is a squamous cell carcinoma of the lung that is arising centrally in the lung (as most squamous cell carcinomas do). It is obstructing the right main bronchus. The neoplasm is very firm and has a pale white to tan cut surface.

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