Nicola James and John Symons welcome a new guideline to improve the management of patients with unknown cancers

NOT EVEN the most cynical person can deny that the delivery of cancer services has improved in the UK over the past ten years. Multidisciplinary teams, specialist nurses, patient information, clearly identified referral and diagnostic pathways with stringent waiting time targets – all have been developed for each major cancer. Except for one: carcinoma of unknown primary (CUP), which is the fourth most common cause of cancer death in England and Wales (National Institute for Health and Clinical Excellence (NICE) 2010).