Enabling Primary Care Access to ‘Cancer of Unknown’ Services

Dr Samah Massalha, ST6 Medical Oncology
Dr Anna Mullard, Consultant Medical Oncologist and MDT Lead
Dr Elaine Hampton, Macmillan GP Facilitator
Dawn Griffiths, Acute Oncology Nurse Practitioner

Betsi Cadwaladr University Health Board


Patients presenting with cancer with no obvious primary do not fit into existing Primary Care cancer referral pathways, such as USC (Urgent Suspected Cancer) referrals. As a result, most patients present as an emergency to hospital.

Once admitted to hospital, these patients will be picked up by the Acute Oncology Service (AOS) and enter into the Unknown Primary Service (UPS).

A pilot project was initiated so that if GPs had a patient with radiological evidence of malignancy with no obvious primary, they could access UPS. The pilot was not extended into routine practice due to difficulties in CT access for these patients.

Project Aims


Referral pathway following GP finding of likely metastatic cancer

Key Outcomes



Next Steps

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Bevan Exemplar Innovation Showcase: December 2020