NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)
When metastatic malignancy is identified without an obvious primary site (Carcinoma of Unknown Primary, CUP), the GP must rapidly initiate baseline diagnostic workup while arranging urgent referral to a specialized oncology multidisciplinary team. Primary care workup includes comprehensive clinical examination (including breast, nodal, pelvic, and digital rectal exams), basic laboratory testing (CBC, liver and renal panels, serum calcium, LDH, and PSA in men), and urgent contrast-enhanced CT of the chest, abdomen, and pelvis. Avoid performing random unguided tumor marker batteries or blind biopsies, and provide immediate supportive symptom control for pain, nausea, and anxiety while specialist staging is organized. - Refer, with advice
Children follow the same pathway: recognise and refer. No primary-care medicine is implied.
No dose - referral pathway, no medicine given in primary care
When metastatic malignancy is identified without an obvious primary site (Carcinoma of Unknown Primary, CUP), the GP must rapidly initiate baseline diagnostic workup while arranging urgent referral to a specialized oncology multidisciplinary team. Primary care workup includes comprehensive clinical examination (including breast, nodal, pelvic, and digital rectal exams), basic laboratory testing (CBC, liver and renal panels, serum calcium, LDH, and PSA in men), and urgent contrast-enhanced CT of the chest, abdomen, and pelvis. Avoid performing random unguided tumor marker batteries or blind biopsies, and provide immediate supportive symptom control for pain, nausea, and anxiety while specialist staging is organized.
- Any classic cancer red flag (unexplained weight loss, palpable mass, unexplained bleeding) needs urgent referral on its own, without waiting for histology.
- Uncontrolled pain, signs of spinal cord compression, or superior vena cava obstruction are same-day emergencies.
- No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.