Intrahepatic cholangiocarcinoma hidden within cancer of unknown primary

Alicia-Marie Conway, Georgina C. Morris, Sarah Smith, Monique Vekeria, Prakash Manoharan, Claire Mitchell, Alison Backen, Pedro Oliveira, Richard Hubner, Angela Lamarca, Mairead Mcnamara, Juan Valle, Natalie Cook

Research output: Contribution to journalArticlepeer-review


Background: Many patients referred with a provisional diagnosis of cancer of unknown primary (pCUP) present with presumed metastatic disease to the liver. Due to lack of definitive histological markers, intrahepatic cholangiocarcinoma (iCCA) may be overlooked. This study assessed the frequency of iCCA within a pCUP cohort.
Methods: A single UK cancer-center study of sequential patients referred with pCUP from Jan-2017–Apr-2020. Baseline diagnostic imaging was reviewed independently by a radiologist and oncologist; those with radiological features of iCCA (dominant liver lesion, capsular retraction) were identified.
Results: Of 228 patients referred with pCUP, 72 (32%) had malignancy involving the liver. 24/72 patients had radiological features consistent with iCCA; they were predominantly female (75%) with an average age of 63 years and 63% had an ECOG PS ≤2. Median overall survival (OS) of the iCCA group and remaining liver-involved CUP group were similar (OS 4.1 vs 4.4 months, p-value = 0.805). Patients where a primary diagnosis was subsequently determined had better OS (10.2 months, p-values: iCCA=0.0279: cCUP=0.0230).
Conclusions: In this study, 34% of patients with liver-involved pCUP, fulfilled the radiological criteria for an iCCA diagnosis. Consideration of an iCCA diagnosis in patients with CUP could improve timely diagnosis, molecular characterisation and treatment.
Original languageEnglish
JournalBritish Journal of Cancer.
Publication statusAccepted/In press - 29 Mar 2022

Research Beacons, Institutes and Platforms

  • Manchester Cancer Research Centre


Dive into the research topics of 'Intrahepatic cholangiocarcinoma hidden within cancer of unknown primary'. Together they form a unique fingerprint.

Cite this