Investigating the adenocarcinoma of unknown origin (ACUP): a cost benefit analysis

This paper attempts to assess three approaches to the investigation of a patient with histological metastatic adenocarcinoma when the primary tumour of origin is not clear on the initial presentation. These different approaches are evaluated semi-quantitatively. Estimated costs and morbidity of investigations and treatment, increased survival, and improvement in quality of life are taken into account in this analysis. A sample schema of investigation which will maximise the potential benefit as well as minimise the cost to the health service resources and the human cost to the patient is proposed.