Cancer of unknown primary site. Deciding how far to carry evaluation

Management of most patients who present with metastatic cancer from an unknown primary site is challenging. These patients often are debilitated from the onset of their disease, have symptoms that are hard to control, and respond poorly to systemic therapy. The decision regarding the extent of a frequently unrewarding diagnostic evaluation, especially in these days of cost containment, is difficult. Knowing that few will benefit from aggressive therapy, the treating physician should make quality of life the most important goal in caring for these patients.