The Primary
Cancer is caused by a number of changes (mutations) in the genes in our body that control cell growth or regulate the detection and repair of DNA damage. Often there is more than one gene involved in cancer development.
Cancer is the result of accumulated mutations to a person's DNA. The mutations that can lead to cancer may be inherited or acquired. Multiple events have to occur to cells before cancer occurs (which is why few children get cancer, unless it is through inherited damage, and those over 60 are more likely to get cancer).
Mutations may result through a loss of activity in Tumour Supressor Genes (the brakes), or enhanced activity by Oncogenes (accelerators), that regulate the way our cells work. So, whilst we may have a genetic predisposition to a particular cancer it needs further "hits" to turn this into cancer. The damage or additional damage can be caused by a wide variety of factors such as: lifestyle (diet, drink, smoking, sunbathing etc.), radiation exposure, stress, viral infection, chemicals.
The point of origin in the body, where the genes have caused cells to grow uncontrollably and form a tumour, is known as the Primary Site. In most cases the primary site is obvious and quickly diagnosed. Conventional medical wisdom suggests the importance of finding the primary; but as diagnosis and medicines get increasingly personalised (e.g. through Molecular Profiling for CUP) it will become a case of: what is the pattern of this disease we need to define a treatment for, rather than where is the primary site?
Strictly speaking one might say that CUP exists from the point someone knows they have cancer until they know for certain the site of the primary. But our concern is with CUP where there has been cancer spread but it is impossible to tell from initial tests (X-rays, blood tests, scans etc.) where the cancer began in the body - and cancer treatment is directed presently at the anatomical starting point or primary.
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The lesson of the last 150 years in oncology is that orthodoxy was repeatedly wrong. Siddhartha Mukherjee in "The emperor of all the maladies: a biography of cancer".
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Many congratulations on establishing such a superb website. Dr Robert H Phillips, Consultant Radiotherapist and Physician in Medical Oncology
This website is a fantastic resource.
Dr Maurice Slevin, Medical Oncologist
Your website is such a good way of providing information that empowers the patient/carer.
Anne (former CUP patient)
This site provides much needed and accessible help for CUP patients and their loved ones - I'm very, very impressed.
Nicola James
Macmillan Nurse Consultant
