Guidance

This guideline covers diagnosing and managing secondary cancer in people aged 18 and over when the site of the primary cancer is unknown. This includes people who have had treatment for cancer before. It aims to improve quality of life by offering advice on tests for identifying the site of the primary cancer and options for managing the person’s condition.

This guideline covers carcinomas only and does not cover, for example, lymphoma, melanoma and sarcoma. For other NICE guidelines on cancer, see the cancer topic page.

In April 2023, we withdrew recommendations on gene-expression-based profiling and added a link to the NHS Genomic Medicine Service’s national genomic test directory.

Recommendations

This guideline includes recommendations on:

Who is it for?

  • Healthcare professionals
  • Commissioners and providers
  • Adults with cancer of unknown primary origin, their families and carers

Is this guideline up to date?

April 2023: We are not updating the guideline. We will monitor for new evidence on diagnosing carcinoma of unknown primary (CUP) in adults and for molecular diagnostic tests to inform managing CUP in adults. For more information, see the surveillance decision.

Guideline development process

How we develop NICE guidelines

This guideline was previously called metastatic malignant disease of unknown primary origin: diagnosis and management of metastatic malignant disease of unknown primary origin.

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.