# Malignancy (Unspecified Primary)

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: Diagnosis and Management of Metastatic Malignant Disease of Unknown Primary Origin - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK82159/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class AD25 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care

## Treatment metadata

- No drug therapy in primary care (Referral & Advice)

## Complete treatment card

```text
MALIGNANCY (UNSPECIFIED PRIMARY)
Sources: Diagnosis and Management of Metastatic Malignant Disease of Unknown Primary Origin - NCBI
         Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK82159/ · ICPC-3 (WONCA International
         Classification of Primary Care, 3rd edition) class AD25 - condition scope only, no dose ·
         No dose - referral pathway, no medicine given in primary care
Review status: REVIEWED against the source listed above  (2026-08)

1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)    [1st line]
   Adult    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
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   Source   No dose - referral pathway, no medicine given in primary care
   Why      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.
   Caution  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.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
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