Many people are surprised to learn that 3 to 5 percent of cancer patients receive a diagnosis of Cancer of Unknown Primary (CUP)1—where the tumor primary origin cannot be found.
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origin → learn → Primary
Liquid biopsy is changing the way we uncover cancer clues, enabling a new way to guide treatment decisions—with a simple blood draw.
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we → change → draw
[The content of this article has been produced by our advertising partner.
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content → produce → partner
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Imagine a detective who finds clear clues at a crime scene but has no idea where the crime actually took place.
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crime → imagine → place
Medicine faces this exact mystery: patients can actually be diagnosed with a specific condition called Cancer of Unknown Primary (CUP)—when standard procedures like medical imaging and tissue biopsies fail to identify where a tumor started. Far more common and aggressive than most people realize, CUP accounts for 3 to 5 percent of all cancer cases and ranks as the fourth worldwide leading cause of cancer death1, with a median survival of just 8 to 12 months2.
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CUP → face → months2
Blood-based CGP has results often available within two weeks.
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CGP → base → weeks
Timely blood-based CGP can rapidly identify actionable targets and expand treatment options.
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CGP → base → options
Case Study: Cancer Diagnostic Deadlock for a Mother in Her 50s
Professor El Helali describes a case that illustrates the life-changing impact of blood-based CGP.
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that → describe → CGP
A patient in her 50s with school-age children presented with widespread liver and lymph node involvement.
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patient → present → involvement
Repeated tissue biopsies showed only differentiated adenocarcinoma (gland cell cancer), extensive immunohistochemistry (tissue staining and imaging tests) and imaging failed to identify the primary site.
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adenocarcinoma → show → site
The tumor was metastatic, not a primary liver cancer, and more than two months of diagnostic work had already passed.
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months → pass → work
“Because the patient could not tolerate further tissue sampling and there was insufficient remaining tissue, the team decided to perform a liquid biopsy for comprehensive genomic profiling and prioritized the test to avoid further delay.”
The expedited blood-based CGP returned in about ten days and revealed a BRAF mutation, a hint from the molecular tumor board – comprising oncologists, pathologists, biologist, data scientists, pharmacists, and surgeons to start a dual targeted therapy.
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CGP → tolerate → therapy
The genomic panel also identified additional mutations to guide alternative options if the initial therapy failed.
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therapy → identify → options
Despite an expected median survival of roughly a few months for CUP2, the patient is still alive at one and a half years and has recently gone on holiday abroad.
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patient → expect → holiday
Beyond CUP: Transforming Precision Lung Cancer Care in Hong Kong
The clinical benefits of liquid genomic profiling extend beyond CUP.
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benefits → transform → CUP
Recently, the United Kingdom’s National Health Service made headlines by incorporating liquid-based genomic profiling into routine diagnostics to fast-track targeted therapies for patients with non-small cell lung cancer (NSCLC).
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Service → make → cancer
In Hong Kong, a territory-wide, multicenter prospective CGP project was conducted across the 7 hospital authority clusters for NSCLC, run by the University of Hong Kong and the Hospital Authority and funded by the Innovation and Technology Commission (ITC)-Hong Kong under the Partnership Research Programme scheme.
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project → conduct → scheme
In this local study of 878 patients, CGP in blood and tissue was interchangeable, only if enough cancer cells were detected in the blood.
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cells → detect → blood
Furthermore, blood can detect emerging gene changes that could alter how we manage a patient’s tumour.
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we → detect → tumour
3,4
Recent advances have extended CGP by adding RNA analysis, which detects gene fusions and actionable treatment targets to guide therapy.
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which → extend → therapy
Blood-based CGP is typically self-financed, though some insurers cover genomic testing – especially when professional guidelines support it, such as the European Society of Medical Oncology.
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guidelines → base → Oncology
In Hong Kong, public hospitals currently lack the infrastructure for a liquid-first diagnostic approach for CUP.
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hospitals → lack → CUP
Clinicians often consider patients’ financial circumstances before recommending blood-based CGP.
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Clinicians → consider → CGP
Ideally, Professor El Helali says, many doctors would start with a liquid biopsy because it is minimally invasive and quickly provides broad molecular information; if the blood test finds nothing actionable, the next step would be tissue biopsy for further testing.
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step → say → testing
The journal of liquid biopsy, 9, 100325. https://doi.org/10.1016/j.jlb.2025.100325
The information provided is intended for informational purposes only and does not constitute medical advice.
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information → provide → advice
The Aporia
