| Abstract: |
(from the chapter) The term "cancer of unknown primary" (CUP) represents a diverse group of diseases which present complex challenges in diagnosis and therapy. Unknown primary cancer represents approximately 2% of current cancer diagnoses. Older series report the incidence to be as high as 7.8%; however, many of these cases would be unlikely to remain of unknown origin with current diagnostic imaging techniques. In general, CUP implies a poor prognosis; older literature indicates extremely limited therapeutic options and an overall median survival of 4-10 months. More recent trials have suggested a somewhat better outcome; however, these trials have been more selective of favorable performance status patients, which may account in total or in part for the better outcomes than some historical comparators. Favorable clinical outcomes are typically limited to those patients in more treatable subgroups of CUP or to instances where a more favorable histological diagnosis can be identified. Oncologic management of CUP consists of: (1) reasonable attempts to establish the CUP diagnosis; (2) a search for alternative diagnoses with better prognoses, and (3) attempts to identify factors which would establish the patient as a member of one of the more treatable subgroups of unknown primary cancer. In this chapter, we provide background medical information that serves to highlight some of the more salient psychological and psychosocial issues that arise within this patient population. Psycho-oncologists need to acknowledge that patients with CUP contend with even higher than typical levels of uncertainty than most cancer patients' face. Also, due to the fact that an unknown primary cancer is by definition metastatic, and therefore advanced, at the time of initial diagnosis, issues reflective of the advanced stage of disease must be confronted quite early in the patient's adjustment to the illness. (PsycINFO Database Record (c) 2011 APA, all rights reserved). |
