This booklet will provide you with information about the cancer of unknown primary (CUP) service, the people who will be involved in your care and how they can help. You will be looked after by the multidisciplinary CUP team at the Royal Free London.

If you would like further information, or have any worries, please do not hesitate to speak to your nurse or doctor. In all cases, a doctor will explain our role and investigations to you and answer any questions you may have.

Most patients are referred to the service because they have had an abnormal scan, which may be suggestive of cancer. Our role is to help work out the best management plan for you in a timely manner and offer you support during this time.

In most cases it will be possible for a friend or relative to accompany you for your appointments and/or procedures. Please ask your nurse or doctor.

The team

The CUP team is made up of a multidisciplinary of healthcare professionals who have a specialist interest, knowledge, and expertise in this area.  

  • Specialist oncologists who specialise in cancer treatments such as chemotherapy or radiotherapy.
  • Pathologists who examine samples such as biopsies to look for particular cancer cell types.
  • Radiologists who perform and interpret x-ray, CT, PET, and MRI scans.  
  • Clinical nurse specialists (CNS) who will offer you a point of contact, information, and support.
  • Palliative care specialists who are experts in relieving pain and other symptoms caused by your illness. The team can assist with social and psychological difficulties caused by your disease.
  • Dietitians who will support your health through food and nutrition.  
  • Multidisciplinary co-ordinator who co-ordinates multidisciplinary team (MDT) meetings and ‘tracks’ your care.

MDT meetings

The MDT meets every Wednesday morning. Each patient’s case is discussed when they reach important points in their diagnosis and treatment. The MDT will discuss your case history, scan images and pathology results (from studying biopsies), together with any other relevant information.  

As a team, they will work out an appropriate plan for your treatment or care. This plan will be discussed with you either over the phone, at an appointment in clinic or on the ward.  

Clinical nurse specialist (CNS) for the CUP service

A CNS is a senior nurse who works as a core member of the MDT. They have specific knowledge and experience of patients with a cancer of unknown primary. They also have specialist knowledge of the treatments that you might be offered.    

CNSs work closely with the oncologist involved in your care. They are also able to put you in contact with other members of the team, such as the doctors, dietitians, palliative care team and other health professionals. You will be told who your CNS is and they will be your key worker.  

How can we help?

Your CNS will aim to offer you and your carers a point of contact for information. They can offer support and advice during any investigations, your treatment and care.  They can offer and discuss information about:

  • Your diagnosis.
  • Investigations and treatment options.
  • Advice on physical and emotional symptoms.
  • Any other issues, concerns or comments you may wish to raise.
  • Links with doctors or other health care professionals.
  • Please do not hesitate to contact your CNS if you need advice about your condition or treatment.

Further information

here are many ways of finding out information about cancer and possible treatments. People who are affected by cancer often need information to help them make informed decisions about their condition, treatment and to help them plan for their future.

The CNSs have access to a range of written national and local information leaflets. Our Macmillan information and support centres also provide valuable sources of information.

Information can be found on the internet but should always be read in relation to what you have been told by your cancer specialists. Please feel welcome to discuss specific questions you have with your CNS.  

Macmillan information and support centre  

Offers advice, support and provides practical, medical, emotional, and financial help to anyone affected by cancer.  Helpline: 0808 808 0000  

Barnet Hospital

Level one, inside main entrance Open Monday to Friday, 10am to 4pm  Chase Farm Hospital Ground Floor Open Monday to Friday, 10am to 4pm.

Royal Free Hospital

Oncology outpatients, ground floor Open Tuesday to Friday 10am to 4pm.