Miscellaneous: CUP: favourable subsets

Why C is correct

Isolated axillary nodal adenocarcinoma in a woman is a recognised favourable CUP subset. NICE CG104 directs that patients with adenocarcinoma involving the axillary nodes are referred to a breast cancer MDT for evaluation and treatment, that is, managed as an occult (stage II-III) breast cancer with curative intent rather than as generic poor-prognosis CUP. The ER-positive adenocarcinoma histology strongly supports an occult breast primary.

And why the others are not

• AAxillary dissection alone undertreats an occult breast primary; NICE CG104 directs management as stage II-III breast cancer - multimodality and curative in intent - not nodal surgery in isolation.
• BEndocrine therapy alone is insufficient; the favourable subset is managed as stage II-III breast cancer by a breast MDT with curative-intent multimodality treatment, of which endocrine therapy may be only one component.
• DHead and neck MDT referral applies to upper- or mid-neck squamous cell carcinoma, not axillary adenocarcinoma.
• EEmpirical platinum chemotherapy is for unfavourable CUP; this favourable subset warrants breast-directed, curative-intent management.

Source NICE CG104 - Metastatic malignant disease of unknown primary origin in adults — National Institute for Health and Care Excellence. Metastatic malignant disease of unknown primary origin in adults: diagnosis and management. NICE guideline CG104. Published July 2010, last updated 2023.