Showing posts with label Bladder Cancer. Show all posts

New Treatment Option Studied For Bladder Cancer

A chemotherapy regimen for patients with advanced bladder cancer who aren’t eligible for standard treatment is under study at the Medical College of Georgia.

he unfortunate reality is that kidney problems often result from bladder cancer which precludes the usual chemotherapy package of cisplatin and gemcitabine, says Dr. Teresa A. Coleman, hematologist-oncologist at the MCG Cancer Center.

A Phase II study at about 120 sites in North America, Europe and Asia will determine if those patients can benefit from vinflunine, which is in the same vinca alkaloid family as Navelbine®, used for lung cancer.

These vinca alkaloids keep cells from dividing properly so the tumor can’t grow and existing tumor regresses, says Dr. Coleman, a principal investigator on the study sponsored by Bristol-Myers Squibb.

Patients with stage two disease, which has spread beyond its origin in the bladder’s lining, typically get cisplatin and gemcitabine before or after surgery or in conjunction with radiation therapy. However, a major side effect of cisplatin is kidney failure, and gemcitabine alone is believed not to be nearly as effective. “The most effective drug we have can’t be used in some patients,” Dr. Coleman says.

Bladder cancer, the sixth most common cancer, often obstructs tubules that connect the kidney to the bladder, says Dr. Coleman. While the cancer typically doesn’t spread upward, tubule blockage damages the kidneys. Additionally, bladder cancer incidence peaks in the 60s and 70s when other diseases, such as type 2 diabetes and uncontrolled blood pressure, may also have damaged the kidneys, she says. These scenarios make more than 50 percent of patients age 70 to 80 and an estimated 30 percent of all bladder cancer patients are ineligible for cisplatin.

“I see so many patients who come to my office with kidney damage for a variety of reasons, and I have little for them really,” says Dr. Coleman. A chemotherapy regimen that includes the drug carboplatin instead of cisplatin – both platinum-based compounds that also keep cancer cells from dividing – is more kidney friendly but less effective than the cisplatin regimen, studies have shown. Bristol-Myers Squibb produces cisplatin and carboplatin.

Participants will either get vinflunine and gemcitabine or gemcitabine alone. They will get the drug regimen intravenously on days one and eight of a 21-day cycle. Patients who do well may continue taking it up to a year or more.

Anemia is the major side effect of vinflunine, which suppresses the bone marrow, but existing anemia does not exclude patients from the trial, Dr. Coleman says.

She hopes the regimen will be at least as effective as the cisplatin therapy, which give patients with non-metastatic disease about a 50-50 chance of living five years. An earlier study in patients with advanced cancer who received a previous chemotherapy regimen, then vinflunine alone, showed 67 percent had their disease stabilized.

Smoking is the number-one risk factor for bladder cancer. The first symptom is often blood in the urine. “Bladder cancer begins in the urinary lining of the bladder,” says Dr. Coleman. “When that lining is disrupted, it’s like pulling layers of skin off. You will bleed into your urine. You can have pain, but that’s usually a later sign.”

Physicians will examine the lining and take a biopsy to determine the extent of the cancer. “If you catch it early, it’s absolutely curable,” Dr. Coleman says. Physicians literally tear off the diseased lining, which will eventually re-grow. If it’s the early stage- one disease, but an aggressive form, BCG, an agent used as a vaccine for tuberculosis that stimulates an immune response, is injected directly into the bladder once a week for six weeks.

The fact that the bladder is literally a sac makes it a target for cancer by holding liquid toxic waste from a smoker’s body, Dr. Coleman says. However, it also means that some patients can get localized treatment for their disease.

New Treatment Option Studied For Bladder Cancer

A chemotherapy regimen for patients with advanced bladder cancer who aren’t eligible for standard treatment is under study at the Medical College of Georgia.

The unfortunate reality is that kidney problems often result from bladder cancer which precludes the usual chemotherapy package of cisplatin and gemcitabine, says Dr. Teresa A. Coleman, hematologist-oncologist at the MCG Cancer Center.

Anemia is the major side effect of vinflunine, which suppresses the bone marrow, but existing anemia does not exclude patients from the trial, Dr. Coleman says.

Extract Of Broccoli Sprouts May Protect Against Bladder Cancer

A concentrated extract of freeze dried broccoli sprouts cut development of bladder tumors in an animal model by more than half, according to a report in the March 1 issue of Cancer Research.

This finding reinforces human epidemiologic studies that have suggested that eating cruciferous vegetables like broccoli is associated with reduced risk for bladder cancer, according to the study's senior investigator, Yuesheng Zhang, MD, PhD, professor of oncology at Roswell Park Cancer Institute. "Although this is an animal study, it provides potent evidence that eating vegetables is beneficial in bladder cancer prevention," he said.

There is strong evidence that the protective action of cruciferous vegetables derives at least in part from isothyiocyanates (ITCs), a group of phytochemicals with well-known cancer preventive activities."The bladder is particularly responsive to this group of natural chemicals," Zhang said. "In our experiments, the broccoli sprout ITCs after oral administration were selectively delivered to the bladder tissues through urinary excretion."

Other cruciferous vegetables with ITCs include mature broccoli, cabbage, kale, collard greens and others. Broccoli sprouts have approximately 30 times more ITCs than mature broccoli, and the sprout extract used by the researchers contains approximately 600 times as much.

Although animals that had the most protection against development of bladder cancer were given high doses of the extract, Zhang said humans at increased risk for this cancer likely do not need to eat huge amounts of broccoli sprouts in order to derive protective benefits.

"Epidemiologic studies have shown that dietary ITCs and cruciferous vegetable intake are inversely associated with bladder cancer risk in humans. It is possible that ITC doses much lower than those given to the rats in this study may be adequate for bladder cancer prevention," he said.

Zhang and his colleagues tested the ability of the concentrate to prevent bladder tumors in five groups of rats. The first group acted as a control, while the second group was given only the broccoli extract to test for safety. The remaining three groups were given a chemical, N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) in drinking water, which induces bladder cancer. Two of these groups were given the broccoli extract in diet, beginning two weeks before the carcinogenic chemical was delivered.

In the control group and the group given only the extract, no tumors developed, and there was no toxicity from the extract in the rats.

About 96 percent of animals given only BBN developed an average of almost two tumors each of varying sizes. By comparison, about 74 percent of animals given a low dose of the extract developed cancer, and the number of tumors per rat was 1.39. The group given the high dose of extract had even fewer tumors. About 38 percent of this high-dose group developed cancer, and the average number of tumors per animal was only .46 and, unlike the other animals, the majority were very small in size.

The study was funded by the Vital Vegetables Research Program of Australia and New Zealand, the National Cancer Institute and the Roswell Park Alliance Foundation.

New Method for Accurate Diagnosis of Gall Bladder Cancer

Researchers a the University of Granada and the Department of Nuclear Medicine, Hospital Virgen de las Nieves at Granada found that the metabolic imaging diagnosis technique -- based on the analysis of a structural analog of glucose labeled with a positron-emitting compound (18F) -- allows early diagnosis of gall bladder cancer, a relatively rare disease with high mortality rates among most patients suffering from it.

For the purpose of this study, 62 patients were subjected to this scanning method, which represents the largest sample of patients with gall bladder cancer ever studied by applying this type of technology -- called FDG positron emission tomography. The study reported excellent results, significantly better than other structural imaging methods, and enabled more accurate and appropriate diagnosis and treatment of patients, which allows to avoid unnecessary procedures.

This study was conducted by Sc.D Carlos Ramos Font and directed by professors Nicolás Olea Serrano (UGR), José Manuel Llamas Elvira (UGR and Department of Nuclear Medicine, Hospital Virgen de las Nieves and Manuel Gómez Río (Department of Nuclear Medicine, Hospital Virgen de las Nieves).

Early Diagnosis Is Essential

The high mortality rate among patients with gall bladder cancer depends heavily on the lack of clinical data enabling early diagnosis of this type of tumors. This fact determines the survival of this type of patients. At the moment of establishing a diagnosis, an accurate staging will allow to chose the most appropriate treatment, as well as to optimize the use of the resources available. Imaging diagnosis of this pathology is essentially based on morphological techniques (echography, X-ray computed tomography and magnetic resonance imaging).

This new imaging diagnosis method (tomography made by emission of positrons with ¹⁸F fluorodeoxyglucose) shows glucose metabolism in tissues. While the utility of this method has been proved in other types of tumors, its utility in gall bladder cancer had not been proved yet.

According to Granada University researchers, their study proves that positron emission tomography scanning wih FDG "is a valid and accurate method for precise staging of patients with suspected gall bladder cancer, which allows to determine the appropriate therapy and treatment, and to optimize the use of the resources available." Thus, they suggest that "each patient with suspected cancer should be subjected to this type of imaging diagnosis, to determine the nature of such process."

The results obtained from this study were partially published in the American Journal of Surgery (2004), the Journal of Surgical Oncology (2006) and the Revista Española de Medicina Nuclear(2009) [Spanish Journal of Nuclear Medicine].

Blood Test May Find Markers of Bladder Cancer Risk

Knowing that it is impossible to catalog all the carcinogenic exposures a person has had in life and then assess them, Brown University researcher Carmen Marsit is looking for a more precise way to predict individual susceptibility to cancer. In a paper published online Feb. 22, 2011, in the Journal of Clinical Oncology, Marsit leads a team of scientists in describing a blood test that can accurately detect biomolecular markers of bladder cancer that risky exposures may have left behind.

The test measures a pattern of "methylation," a chemical alteration to DNA that affects which genes are expressed in cells, that Marsit's team determined is associated with bladder cancer. Methylation is affected by exposures in the environment, such as cigarette smoke and industrial pollutants, so many scientists believe that abnormal patterns of it in the body could be indicators of an increased likelihood of disease.

"What we might be measuring is an accumulated barometer of your life of exposures that then put you at risk," said Marsit, assistant professor of medical science in the Department of Pathology and Laboratory Medicine at the Warren Alpert School of Medicine at Brown University. "Will you ever really figure out if eating something when you were 12 gave you cancer? Instead we can use these kinds of markers as an integrated measure of your exposure history throughout your life."

Prediction or early detection?

To create the test, Marsit's team of scientists at Brown and Dartmouth studied the blood of 112 people who had bladder cancer and 118 who didn't. That gave them the tell-tale pattern of methylation to look for in immune system cells in the blood. Then, under properly blind conditions, they applied that test to the blood of a similar number of people who either had the cancer or didn't, and made their predictions.

They found that they could indeed determine who had the cancer and who didn't, based solely on the methylation pattern they observed. Controlling for the exposure to known risk factors like smoking that the patients reported, the researchers saw that people with the methylation pattern were 5.2 times more likely to have bladder cancer than people who did not have the pattern.

Because the samples used in the study came from people who already had the cancer, Marsit acknowledged that the scientists cannot be sure without further research whether the methylation markers in their immune system cells were predictors of cancer (i.e., they were present before the cancer began growing, as the team's hypothesis suggests) or simply indicated that the cancer was already there (i.e., they are a consequence of the cancer).

At a minimum, the study proves that the cancer is associated with a methylation pattern that can readily be detected in the blood, Marsit said. For cancers that are buried deep in the body and are therefore hard to detect, such as bladder cancer, a minimally invasive test that provides either prediction or early detection of cancer could make a big difference in improving a patient's prognosis, he added.

The researchers in the paper write that testing for methylation in blood cells could also be similarly applicable to other cancers.

Other authors in addition to Marsit include Brown researchers Devin Koestler, Brock Christensen, Andres Houseman, and Karl Kelsey, and Dartmouth researcher Margaret Karagas.

The study was funded by the National Institutes of Health and the Flight Attendants Medical Research Institute.

New Study of the Molecular Roots of Recurrent Bladder Infections Could Lead to a Vaccine

Urinary-tract infections are the second most common bacterial infection in humans, and many of them are recurrent. A study published Feb. 14 by Cell Press in the journal Immunity reveals the cellular and molecular basis of recurrent bladder infections and suggests possible treatment strategies, such as vaccines, to prevent this common problem.

"Our study shows for the first time that the bladder is unable to mount an effective immune response to bacteria, which could explain the high frequency of recurrent infections," says senior study author Soman Abraham of Duke University Medical Center. "These observations give us a new understanding of how immune responses are regulated in the bladder and may have implications for the treatment of recurrent infections."

Urinary-tract infections are caused by Escherichia coli (E. coli), and the bladder in particular is prone to recurrent infections, but it is not known why. Some organs, such as the gut, that store waste products are considered "immune-privileged sites," which need to tolerate the presence of microbes. As a result, the immune system does not activate as readily. Similarly, the bladder might require subdued immune responses to tolerate its contents (e.g., proteins in urine), prevent autoimmunity, and minimize tissue damage. If the bladder were an immune-privileged site, it might explain why it is prone to recurrent infections. But until now, the bladder has not been considered an immune-privileged site, so it has not been clear how this organ balances host defense with microbe tolerance.

In the new study, Abraham and his team found that E. colipersists in the bladders of mice for weeks after initial infection. These mice failed to produce antibodies against E. coli in response to initial infection or recurrent infection, suggesting that immune memory was impaired. The persistence of bacteria and suppressed immune responses in the bladder were mediated by the production of the molecule interleukin-10 by mast cells, which previously were known for their role in mounting immune responses against bacteria during the early stages of bladder infection. The results reveal that mast cells play a complex and key role in balancing host defense and tolerance in the bladder and in maintaining this organ as an immune-privileged site.

"The study suggests that provoking a strong immune response in the bladder through vaccination may be a possible strategy to prevent recurrent infections," Abraham says. "Moreover, the findings could influence our understanding of additional conditions involving the bladder, such as bladder cancers."

Telerobotic System Designed to Treat Bladder Cancer Better

Although bladder cancer is the sixth most common form of cancer in the U.S. and the most expensive to treat, the basic method that doctors use to treat it hasn't changed much in more than 70 years.

An interdisciplinary collaboration of engineers and doctors at Vanderbilt and Columbia Universities intends to change that situation dramatically. Headed by Nabil Simaan, associate professor of mechanical engineering at Vanderbilt, the team has developed a prototype telerobotic platform designed to be inserted through natural orifices -- in this case the urethra -- that can provide surgeons with a much better view of bladder tumors so they can diagnose them more accurately. It is also designed to make it easier to remove tumors from the lining of the bladder regardless of their location -- an operation called transurethral recession.

"When I observed my first transurethral resection, I was amazed at how crude the instruments are and how much pushing and stretching of the patient's body is required,"Simaan said.

That experience inspired the engineer to develop a system that uses micro-robotics to perform this difficult type of surgery. Its features and capabilities are described in an article titled "Design and Evaluation of a Minimally Invasive Telerobotic Platform for Transurethral Surveillance and Intervention" published in the April issue of the journal IEEE Transactions on Biomedical Engineering.

The specialized telerobotic system "doesn't take the judgment out of surgeons' hands, it enhances their capabilities and hopefully gives them surgical superpowers,"commented S. Duke Herrell, an associate professor of urologic surgery and biomedical engineering, who specializes in minimally invasive oncology at Vanderbilt University Medical Center and is collaborating on the project.

The traditional method, which Simaan observed, involves inserting a rigid tube called a resectoscope through the urethra and into the bladder. The instrument contains several channels that allow the circulation of fluid, provide access for an endoscope for observation and interchangeable cauterizing tools used to obtain biopsy tissue for evaluating the malignancy of the tumor and to resect small tumors. In some operations, surgeons replace the cauterizing tool with an optical-fiber laser to destroy tumor cells.

Although the endoscope can give a good view of the bladder lining directly across from the opening of the urethra, inspecting the other areas is more difficult. The medical team must press and twist the scope or push on the patient's body to bring other areas into view. These contortions are also necessary when removing tumors in less accessible areas.

If the surgeon, using endoscopic observation or biopsy, determines that a tumor is invasive and has penetrated the muscle layer, then he later performs a cystectomy that removes the entire bladder through an incision in the abdomen. Frequently this is done using a normal surgical robot. But, when the surgeon judges that the tumor is superficial -- restricted to the bladder lining -- then he attempts to remove it using the resectoscope.

Bladder cancer is so expensive to treat in part because the tumors in the bladder lining are exceptionally persistent and so require continuing surveillance and repeated surgeries. Among the factors that contribute to this persistence is the difficulty of accurately identifying tumor margins and failure to remove all the cancerous cells.

"Because you are working through a long, rigid tube, this can be a difficult procedure, especially in some areas of the bladder," said Herrell.

The telerobotic system is designed specifically to operate in this challenging environment. The machine itself is the size and shape of a large Thermos bottle but its business end is only 5.5 millimeters in diameter -- about one fifth of an inch -- and consists of a segmented robotic arm. The tiny arm can curve through 180 degrees, allowing it to point in every direction including directly back at its entry point. At the tip of the arm is a white light source, an optical fiber laser for cauterization, a fiberscope for observation and a tiny forceps for gripping tissue.

The engineers report that they can control the position of the snake-like arm with sub-millimeter precision: a level adequate for operating in clinical conditions. They have also demonstrated that the device can remove tissue for biopsies by gripping target tissue with the forceps and then cutting it off with the laser.

The fiberscope produced a 10,000-pixel image that was directed to a digital video camera system. Because it is steerable, the instrument was able to provide closeup views of the bladder walls at favorable viewing angles. However, the testing revealed the camera system's effectiveness was limited by poor distance resolution. According to the researchers, this can be corrected by re-designing the fiberscope or by replacing it with a miniature camera tip.

In the future, the researchers intend to incorporate additional imaging methods for improving the ability to identify tumor boundaries. These include a fluorescence endoscope, optical coherence tomography that uses infrared radiation to obtain micrometer-resolution images of tissue and ultrasound to augment the surgeon's natural vision.

In addition to these observational methods, the researchers have given their robot arm a sense of touch. Using a technique called force-feedback, they can measure the force acting on the tip when it comes into contact with tissue. Normally, tumors protrude from the surrounding tissue. Vanderbilt Ph.D. candidate Andrea Bajo used this fact to successfully design new algorithms that allow the robot arm in the device to accurately trace a tumor's edge. He did so by positioning the tip on the edge of a tumor and instructing it to move in the direction that maintains the same pressure.

"Surgeons can typically identify the gross visual margin of a tumor within a millimeter, but a robot like this has the potential of doing so with sub-millimetric precision and additional technologies may actually be able to distinguish margins at the cellular level," said Herrell.

The team plans to make use of this level of precision to program the robot to perform what surgeons call an "en-block resection," the removal of an entire tumor plus a small margin of normal tissue in one operation. That procedure is designed to ensure that no cancerous cells are left behind that can reseed the tumor.

The engineers are also using the system's capabilities to design a number of safety measures into the telerobotic system. For example, the operator can set a maximum depth that the laser will cut and, even if the operator's hand slips, the robot will not cut any deeper.

These safety measures are an example of Simaan's primary research goal: develop surgical robotic systems that can be inserted into the human body and interact safely with it.

Work on this system began with Simaan's former Ph.D. student Roger Goldman and Lara Suh-MacLachlan at Columbia University. Ryan Pickens, a fellow at Vanderbilt University Medical Center, is also a team member. Simaan and Bajo received partial support from NSF Career grant #IIS-1063750.

Metastatic Cancer

What is metastatic cancer?

Metastatic cancer is cancer that has spread from the place where it first started to another place in the body. A tumor formed by metastatic cancer cells is called a metastatic tumor or a metastasis. The process by which cancer cells spread to other parts of the body is also called metastasis.

Metastatic cancer has the same name and the same type of cancer cells as the original, or primary, cancer. For example, breast cancer that spreads to the lung and forms a metastatic tumor is metastatic breast cancer, not lung cancer.

Under a microscope, metastatic cancer cells generally look the same as cells of the original cancer. Moreover, metastatic cancer cells and cells of the original cancer usually have some molecular features in common, such as the expression of certain proteins or the presence of specific chromosome changes.

Although some types of metastatic cancer can be cured with current treatments, most cannot. Nevertheless, treatments are available for all patients with metastatic cancer. In general, the primary goal of these treatments is to control the growth of the cancer or to relieve symptoms caused by it. In some cases, metastatic cancer treatments may help prolong life. However, most people who die of cancer die of metastatic disease.

Can any type of cancer form a metastatic tumor?

Virtually all cancers, including cancers of the blood and the lymphatic system (leukemia, multiple myeloma, and lymphoma), can form metastatic tumors. Although rare, the metastasis of blood and lymphatic system cancers to the lung, heart, central nervous system, and other tissues has been reported.

Where does cancer spread?

The most common sites of cancer metastasis are, in alphabetical order, the bone, liver, and lung. Although most cancers have the ability to spread to many different parts of the body, they usually spread to one site more often than others. The following table shows the most common sites of metastasis, excluding the lymph nodes, for several types of cancer:

Cancer type	Main sites of metastasis*
Bladder	Bone, liver, lung
Breast	Bone, brain, liver, lung
Colorectal	Liver, lung, peritoneum
Kidney	Adrenal gland, bone, brain, liver, lung
Lung	Adrenal gland, bone, brain, liver, other lung
Melanoma	Bone, brain, liver, lung, skin/muscle
Ovary	Liver, lung, peritoneum
Pancreas	Liver, lung, peritoneum
Prostate	Adrenal gland, bone, liver, lung
Stomach	Liver, lung, peritoneum
Thyroid	Bone, liver, lung
Uterus	Bone, liver, lung, peritoneum, vagina

*In alphabetical order. Brain includes the neural tissue of the brain (parenchyma) and the leptomeninges (the two innermost membranes—arachnoid mater and pia mater—of the three membranes known as the meninges that surround the brain and spinal cord; the space between the arachnoid mater and the pia mater contains cerebrospinal fluid). Lung includes the main part of the lung (parenchyma) as well as the pleura (the membrane that covers the lungs and lines the chest cavity).

How does cancer spread?

Cancer cell metastasis usually involves the following steps:

o Local invasion: Cancer cells invade nearby normal tissue.

o Intravasation: Cancer cells invade and move through the walls of nearby lymph vesselsor blood vessels.

o Circulation: Cancer cells move through the lymphatic system and the bloodstream to other parts of the body.

o Arrest and extravasation: Cancer cells arrest, or stop moving, in small blood vessels called capillaries at a distant location. They then invade the walls of the capillaries and migrate into the surrounding tissue (extravasation).

o Proliferation: Cancer cells multiply at the distant location to form small tumors known as micrometastases.

o Angiogenesis: Micrometastases stimulate the growth of new blood vessels to obtain a blood supply. A blood supply is needed to obtain the oxygen and nutrients necessary for continued tumor growth.

1. Because cancers of the lymphatic system or the blood system are already present inside lymph vessels, lymph nodes, or blood vessels, not all of these steps are needed for their metastasis. Also, the lymphatic system drains into the blood system at two locations in the neck.

The ability of a cancer cell to metastasize successfully depends on its individual properties; the properties of the noncancerous cells, including immune system cells, present at the original location; and the properties of the cells it encounters in the lymphatic system or the bloodstream and at the final destination in another part of the body. Not all cancer cells, by themselves, have the ability to metastasize. In addition, the noncancerous cells at the original location may be able to block cancer cell metastasis. Furthermore, successfully reaching another location in the body does not guarantee that a metastatic tumor will form. Metastatic cancer cells can lie dormant (not grow) at a distant site for many years before they begin to grow again, if at all.

2. Does metastatic cancer have symptoms?

Some people with metastatic tumors do not have symptoms. Their metastases are found by x-rays or other tests.

When symptoms of metastatic cancer occur, the type and frequency of the symptoms will depend on the size and location of the metastasis. For example, cancer that spreads to the bone is likely to cause pain and can lead to bone fractures. Cancer that spreads to the brain can cause a variety of symptoms, including headaches, seizures, and unsteadiness. Shortness of breath may be a sign of lung metastasis. Abdominal swelling or jaundice (yellowing of the skin) can indicate that cancer has spread to the liver.

Sometimes a person’s original cancer is discovered only after a metastatic tumor causes symptoms. For example, a man whose prostate cancer has spread to the bones in his pelvis may have lower back pain (caused by the cancer in his bones) before he experiences any symptoms from the original tumor in his prostate.

3. Can someone have a metastatic tumor without having a primary cancer?

No. A metastatic tumor is always caused by cancer cells from another part of the body.

In most cases, when a metastatic tumor is found first, the primary cancer can also be found. The search for the primary cancer may involve lab tests, x-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, positron emission tomography (PET) scans, and other procedures.

However, in some patients, a metastatic tumor is diagnosed but the primary tumor cannot be found, despite extensive tests, because it either is too small or has completely regressed. Thepathologist knows that the diagnosed tumor is a metastasis because the cells do not look like those of the organ or tissue in which the tumor was found. Doctors refer to the primary cancer as unknown or occult (hidden), and the patient is said to have cancer of unknown primary origin(CUP).

Because diagnostic techniques are constantly improving, the number of cases of CUP is going down. More information can be found in the Carcinoma of Unknown Primary Treatment (PDQ®)summary, which is part of NCI’s comprehensive cancer information database.

4. If a person who was previously treated for cancer gets diagnosed with cancer a second time, is the new cancer a new primary cancer or metastatic cancer?

The cancer may be a new primary cancer, but, in most cases, it is metastatic cancer.

5. What treatments are used for metastatic cancer?

Metastatic cancer may be treated with systemic therapy (chemotherapy, biological therapy,targeted therapy, hormonal therapy), local therapy (surgery, radiation therapy), or a combination of these treatments. The choice of treatment generally depends on the type of primary cancer; the size, location, and number of metastatic tumors; the patient’s age and general health; and the types of treatment the patient has had in the past. In patients with CUP, it is possible to treat the disease even though the primary cancer has not been found.

6. Are new treatments for metastatic cancer being developed?

Yes, researchers are studying new ways to kill or stop the growth of primary cancer cells and metastatic cancer cells, including new ways to boost the strength of immune responses against tumors. In addition, researchers are trying to find ways to disrupt individual steps in the metastatic process.

Before any new treatment can be made widely available to patients, it must be studied in clinical trials (research studies) and found to be safe and effective in treating disease. NCI and many other organizations sponsor clinical trials that take place at hospitals, universities, medical schools, and cancer centers around the country. Clinical trials are a critical step in improving cancer care. The results of previous clinical trials have led to progress not only in the treatment of cancer but also in the detection, diagnosis, and prevention of the disease. Patients interested in taking part in a clinical trial should talk with their doctor.