VI.  BACKGROUND. Metastatic CUP is a common entity, accounting for 2.3% of all cancers reported to the Surveillance, Epidemiology, and End Results (SEER) database between 1973 and 1987. It represents the seventh to eighth most common type of cancer and the fourth commonest cause of death in both men and women. The median age at presentation is approximately 60 years, and it is slightly more prevalent in men.

      The characteristic of CUP is the development of metastases before the primary tumor becomes detectable. These tumors are characterized by early dissemination, unpredictable metastatic spread, and very aggressive behavior.

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