Tests
We include here some brief notes on possible tests that an oncologist may ask you to have if the initial tests have failed to identify your cancer. For CUP you may have a large number of tests to allow the specialists to gain as much detail as possible from different perspectives. The oncologist will judge which tests are likely to be most useful based on the site(s) of the cancer spread. In addition to those shown below, tests may involve a further blood sample to identify tumour markers and probably a biopsy where this is practical. The surgeon is likely to need an "adequate" tissue sample from a biopsy; a Fine Needle Aspiration (FNA) will probably not be adequate.
Do be careful to follow any special instructions you are given about fasting, for example, to ensure accurate results.
MRI – Magnetic Resonance Imaging. A powerful magnet is combined with a computer to produce images that can be interpreted by a radiologist. Sometimes a dye is used. There are no known side effects. This may not be used if you have a pacemaker or other implants. The scanner can see down to about 2 millimetres.
CT / CAT– Computerised Axial Tomography. This uses low level x-rays with a computer to produce pictures of layers of the human body (like looking at a slice of bread without actually cutting into the loaf). Sometimes a drink or injection of dye is necessary to allow the radiologist to see the images clearly. The information from the CT Scan is often combined with the output from the PET Scan by the oncologist.
PET - Positron Emission Tomography. This scan can show how body tissues are working, as well as what they look like. With a PET scan you first have an injection of a very small amount of a radioactive tracer. The amount of radiation is no more than you have during a normal X-ray and it only stays in the body for a few hours. The radioactive substance will travel to particular parts of your body. The most common substance is a radioactive version of glucose which shows-up cancers because they use glucose in a different way from normal tissue.
Mammogram. A mammogram is an X-ray of the breasts.
Ultrasound. An Ultrasound uses sound waves to build up a picture of the inside of the body. They are completely painless. The ultrasound scanner has a microphone which gives off sound waves. The sound waves bounce off the organs inside your body, and are picked up again by the microphone as they bounce back. The microphone is linked to a computer. This turns the reflected sound waves into a picture.
Endoscopy. An endoscopy is a test that looks inside the hollow organs of the body such as the stomach using a long flexible tube that you swallow. It has a camera and light inside it which allows a specialist to see if there are any growths or other abnormal looking areas and to take samples (biopsies) if necessary. Most people are given a choice between having the test while they are awake with a numbing spray, or being sedated.
Colonoscopy. A flexible tube, as Endoscopy above, that allows exploration of the colon and rectum.
PSA - Prostate Specific Antigen- test. PSA is a protein produced by both normal and cancerous prostate cells. A high level of PSA can be a sign of cancer.
You can gain further information on these tests from Cancer Research UK.
For those with an iPhone there are a number of applications available that provide information about tests and cancer in general.
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Click here to order the Macmillan Cancerbackup booklet on CUP. It is free of charge to health and social care professionals and those affected by cancer. (On the order page search for Cancer of Unknown Primary or look under cancer type.) Or call 0800 500 800 in the UK to order.
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