Cancer with Unknown Primary Site (CUP) is defined as a condition in which cancer cells are found in the body, but the primary site where the cancer start in the first place cannot be determined.
Symptoms of CUP
Symptoms is completely depending to the type of secondary cancer and some symptoms of the primary cancer, but in this case, it is not. The general symptoms include
1. Unintentional weight loss
Weight loss of over 10% unintentionally.
2. Loss of appetite
A general symptoms for patient with cancer
3. Fatigue and tiredness
Due to above symptoms
4. Anemia and bone pain.
If cancer affects the production of cells in the bone marrow
Causes and risk factors
As mentioned above, it is totally depended to type of secondary cancer, but the general causes and rick factors can be
Due to wear and tear over life long activity, the elder body is no longer function at its optimal stage, and susceptible more of diseases, including cancers. Elder people account to high percentage of cancers than younger age groups.
Cigarette contains high amount of carcinogens, which can lead to many types of cancer
Ultraviolet can caused damage to skin, causing skin cancer
4. Ionizing radiation
One of the causes of thyroid cancer
5. Certain chemicals and other substances
Chemicals and substances can cause mutation of DNA in the cells, causing cancers
6. Some viruses and bacteria
Certain viruses and bacteria can weakened the immune system, leading to the risk of cancer development
Over productions of certain hormones such as estrogen can lead to increased risk of cancer.
8. Family history
Increased risk of cancer if a person has a family history of cancer
9. Excessive drinking
Heavy drinkers are at risk of liver cancer
Fat cells can interfere with production of certain hormones
11. Gene defects
Risk of cancer increased with certain gene defects, such as mutation of BRCA1 and BRCA2 in breast cancer
Where is the primary cancer site
1. If lymph nodes in the neck and biopsy indicates it is cancer, the primary site may be found in the mouth,throat pharynx, thyroid or upper part of the airway.
2. Lymph nodes in the armpit
The primary cancer may be located in the breast in women and small cells ling cancer in men.
3. A shallow of chest X ray
The primary cancer may be located in the lung or bowel or pancreas.
4. Fluid in the abdomen
The primary cancer may be located in cervix, ovary, endometrium in women and bowel in men.
5. Lymph nodes in the groin
The primary cancer may be located cervix, endometrium vulva, ovary, pelvic in women and bowel in both men and women
6. Abnormality of liver scan
The primary cancer may be located bowel, breast, lung.
7. Generalize cancer
Some primary cancers can causes cancer anywhere in the body, including lymphomas, melanomas, etc.
Diagnosis and tests
Types of diagnosis are depended to your symptoms, family history, medical history, past occupation, lifestyle, how the cancer has spread and and experience of your doctor after the careful physical exam.
1. Blood test
The blood is to determine the levels of markers, protein of the primary cancer if it can be found.
2. Chest X ray
Check X ray is to check the lung if the secondary tumor is in the chest.
3. CT Scan (computerized tomography)
A CT scan generates a large series of two-dimensional X-ray images taken around a single axis of rotation, to create a three-dimensional picture of the inside of the body in details.The pictures are viewed by your doctor to see the extent of the tumors abnormalities, such as spreading of cancer to the nearby structure and lymph nodes.
4. MRI scan (magnetic resonance imaging)
MRI (magnetic resonance imaging) is one of many advanced technology used to visualize internal structures cross sectional imaging of your body used effectively in providing the better details of the metastasis of cancer in the lymph nodes and surrounding areas.
Ultrasound allows your doctor to visualize and assess the size and to check for any abnormality and surrounding area with image taken from the test.
6. Positron emission tomography (PET scan)
Positron emission tomography (PET scan) is a type of nuclear medicine imaging with the uses of small amounts of short-lived radioactive material, either injected into a vein, swallowed or inhaled as a gas which will appear in the area of the body being examined, where it gives off energy in the form of gamma rays detected by a camera of positron emission tomography that produces a three-dimensional image or picture of functional processes of the organs in the body, such as the lungs, brain, liver, or other organs.
Endoscopy is thin, tube-like instrument with camera and light at the end to view your stomach by passing it through your mouth and esophagus to the stomach. spray anesthesia is
applied to the throat area.
mammogram is a low-dose x-ray of the breast tissue to screen and detect any breast tissue abnormally and any sign of tumor. mammograms can detect between 85 to 90 percent of all abnormalities, including breast cancer, cysts, fibroadenomas, tumors, etc. even before you can feel a lump.
9. Barium x-rays
In this test, you require to drink a white liquid which will show up on the X ray to check for structural and motility abnormalities of the stomach.
10. Bone scan
It is a nuclear scanning test, beside mostly used in identifying new areas of bone growth and damage to the bones breakdown, it can also evaluates the metastasis (spread) of cancer in the bone..
11. Others such as Urine tests, faecal occult blood (FOB), etc.
A. How to avoid
Since there are no primary cancer is found, how to avoid has become more general
1. Avoid certain chemical agents
Chemicals and certain substances can increase the risk of cancer.
2. Lose weight
Increased risk of certain certain for obese men and women
Cigarette contain cancer causing carcinogens.
Excessive alcohol drinking has been proven to be one of major risk of certain cancers.
5. HIV infection
Researchers found that men infected with the human immunodeficiency virus (HIV) are at higher risk of certain cancers.
Exposure to certain chemical carcinogens in the foods of first 20 years of life or over a prolonged period of time may increase the risk of certain cancers.
7. Using non-steroidal anti-inflammatory drugs
In experimental and epidemiologic (nonrandomized) studies, along with randomized clinical trials, have shown that NSAIDs may have a prophylactic effect against certain cancers.
8. Eating organic healthy foods are always helpful in preventing long-term stomach inflammation.
9. Eat less red meat and fat
In an Red-meat lovers may have a greater likelihood of developing certain cancers of the throat and stomach than people who limit their intake of steaks and hamburgers, a new study suggests.
10. Exposure to radiation
Researchers found that high doses of radiation caused increase the risk of soft-tissue sarcomas in some patients.
1. Green tea
In some clinical studies researchers suggested that the polyphenols in green tea, may play an important role in the prevention of cancer by killing cancerous cells and stopping their progression.
An analysis of several case-controlled studies in Europe suggests an inverse association between garlic consumption and risk of common cancers.
3. Cruciferous vegetables
Cruciferous vegetables such as cauliflower, broccoli, cabbage, etc. beside contain high amount of antioxidants, but also phytonutrients that have been shown to help prevent the onset and halt the progression of certain cancers.
In laboratory studies, saponins have shown the ability to inhibit the reproduction of cancer cells and slow the growth of tumors in several different tissues.
Carrot contains high amount of beta carotene which has shown to induce appotosis of cancer cells. In study of Cell Cycle Regulation and Induction of Apoptosis by β-carotene, researchers found that in vivo study warrants further confirmation that β-carotene acts as apoptosis agent in cancer cells particularly leukemia cells but not normal cells.
C. Nutritional supplements
1. Free radicals scavengers
Vitamin A, C, E are free radical scavengers enhanced the immune system against the forming of free radicals and prevent the alternation of cell DNA cause of abnormal cell growth. For more information of how antioxidants help to treat cancer, click here
Research showed that selenium has a protective effect on various stages of cancer, including both the early and later stages of the disease. In a study in large groups of people, researchers found that in areas of the world where selenium levels in the soil are high, death rates from cancer are significantly lower than in areas where selenium levels are low.
3. Beta -carotene
In some laboratory, animal, and human studies, researchers found that vitamin A, certain retinoids may also inhibit cancer development.
Many studies showed that antioxidant lycopene in tomato inhibits cancer cell growth and exhibit apoptosis, causing cell death.
Phytochemicals are under active research for possible benefits immune system, and as anti-cancer agents. Flavonoids found abundant in berry, inhibit caner cell in vitro study.
A. In conventional medicine
The objective of the treatment is to cure. If the above diagnosis and tests detect the primary cancer site then standard treatment to such type of cancer will be applied. Unfortunately, if the primary cancer can not be found after all diagnosis have been exhausted, curing has become impossible. Treatment now relies on the specific symptoms and where the secondary cancer first appeared.
a. Radiation may be used to kill any cancer cell remaining in the body locally. By using high-energy x-rays or other types of radiation, radiation therapy kills the cancer cells and keep them from growing or regrowing.
b. Side effects
b.2. Chest pain
b.3. Heart problem
b.4. Short of breath
b.5. Skin discoloration or pinkness, irritation.
a. Chemotherapy is most use to treat with advance stage of cancer combined with radio therapy, as it has spread to a distant parts of the body by using drugs taken by mouth or injected into a vein or muscle of the patient to stop the growth of or to kill cancer cells. In sarcoma soft tissue, chemo is recommended to shrink the tumor if surgery is not possible in the place
b. Side effects
b.3. Hair loss
b.6. Mouth sores taste and smell changes
CUP does not respond well to chemotherapy in general.
B. Herbal medicine
Celandine is a herbaceous perennial plant, genus Chelidonium, belonging to the family Papaveraceae, native to Europe and western Asia and introduced widely in North America.
In a study of Ukrain (Ukrain is an anticancer drug based on the extract of the plant)– a new cancer cure? A systematic review of randomised clinical trials, researcher suggested, according to the data from randomised clinical trials that Ukrain to have potential as an anticancer drug. However, numerous caveats prevent a positive conclusion, and independent rigorous studies are urgently needed.
2. Devil’s Claw
The extract of Harpagophytum procumbens, commonly known as devil’s claw,
In vitro studies, researchers found that cat’s claw demonstrated anticancer effects against several cancer cell lines and has been reported to be effective in the treatment of lymphoma cancer, according to a study conducted by K. S. Wilson, M.D., which was published in the journal “Current Oncology” in August 2009.
Fenugreek is used both as a herb (the leaves) and as a spice (the seed), genus Trigonella, belonging to family Fabaceae. Vitro studies have shown that fenugreek exhibits chemopreventive properties against certain cancers.
In a study conducted by S. Uddin and colleagues at the Department of Human Cancer Genomic Research at King Faisal Specialist Hospital and Research Center in Saudi Arabia, researchers found that Curcumin in turmeric may inhibit the proliferation of lymphoma cancer by modulating cell cycling and inducing apoptosis.
5. Asparagus Cochinchinensis
In vitro studies researchers found that curcumin acts as a weak phytoestrogen, exhibits neuroprotective, antiproliferative and preventative effects against cancer.
C. Traditional Chinese medicine
1. Pu Kong Yin (Dandelion Root)
In a study of the efficacy of dandelion root extract in inducing apoptosis in drug-resistant human melanoma cells, researchers found that treatment with this common, yet potent extract of natural compounds has proven novel in specifically inducing apoptosis in chemoresistant melanoma, without toxicity to healthy cells.
2. Gan Cao
Gan Cao is also known as Licorice root. In-vitro, researchers found that saponins in Gan Cao stimulate the immune system and inhibit Epstein-Barr virus expression and possess anti-cancer activities.
3. Bai Hua She She Cao
The Sanjiv Kumar YADAV, Shao Chin LEE(Yong Loo Lin School of Medicine, National University of Singapore researcher results showed that the ethanol extract from Bai Hua She She Cao effectively evokes cancer cell apoptosis, possibly through burst-mediated caspase activation.
4. Huang Qi
In study of Astragalus-Based Chinese Herbs and Platinum-Based Chemotherapy for Advanced Non–Small-Cell Lung Cancer: Meta-Analysis of Randomized Trials, researchers found that astragalus may increase effectiveness of platinum-based chemotherapy when combined with chemotherapy. These results require confirmation with rigorously controlled trials.
According to the American Cancer Society, the substances, licochalcone-A, licocoumarone and glabridin, which are present in licorice root, may prevent mutations in the DNA and kill existing cancer.
5. Ling Zhi
Ling Zhi one of many herbs, has been used over thousands of year in treating abnormal cells growth in traditional Chinese and herbal medicine. In a study , researcher found that cancer cells responded to the herb much in the same way as they would react to chemotherapy drugs. Yet unlike chemotherapy drugs, which can also be toxic to healthy cells, herbal extracts were more deadly to cancer cells than to normal cells, indicating that they have some ability to specifically target cancer.
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