It is important for patients with CUP to be recognised as early as possible so that specialist assessment and management is not delayed and futile investigations are avoided.

In order to achieve this, a clear definition of CUP is required so that patients can be directed along a specialised pathway analogous to the pathways for existing tumour streams where possible.

Patients often present to their general or primary medical practitioner with heterogeneous, non- specific symptoms and abnormal test results that demonstrate very likely metastatic malignancy but without a clear primary site on history or initial investigations.

While some people may have no symptoms, common symptoms may include (Cancer Council Australia 2017, Vajdic & Goldstein 2015):

• loss of appetite
• fatigue
• weight loss
• breathlessness or discomfort in the chest
• cough
• persistent pain (for example, bone, back, abdomen)
• swelling of the abdomen
• jaundice
• swollen lymph glands
• headaches.