Introduction:

Currently, the approach for primary cancer of unknown site with liver metastases remains a diagnostic challenge for the clinician. There is a very broad study algorithm in which the tools used for diagnosis are varied and their use depends on clinical manifestations, radiological findings or a histological result. The cancer of unknown primary site comprises a group of metastatic tumors in which their origin can not be determined despite a standardized study protocol. It represents 3-5% of all tumors, affects both genders, The average age of diagnosis is 60 years. Eighty percent of the patients have a poor prognosis and the mean time of survival is 6 months.

Objective:

To identify patients with cancer of unknown primary site with hepatic metastases, referred to the digestive endoscopy unit and the number of cases with involvement of the digestive tract to identify the diagnostic utility of gastrointestinal endoscopy.

Material and methods:

Retrospective, descriptive study in a 6 years period. Patients referred to the digestive endoscopy unit with diagnosis of an cancer of unknown primary site with hepatic metastases. Inclusion criteria: Definite diagnosis of cancer of unknown primary site with hepatic metastases. Exclusion criteria: absence of clinical file. We reviewed 25,140 endoscopic reports (16,212 panendoscopies and 8,928 colonoscopies).504 cases were included. We excluded 42 patients because they did not have a clinical record, leaving a total of 462.

Results:

Total: 462 cases (250 women, 212 men), average age 62 years (27- 90). Each one underwent panendoscopy and colonoscopy. In 50% the primary tumor was found in the endoscopic study, 38% was diagnosed by other methods and in 12% the primary tumor was not found. The findings were: colon and rectal adenocarcinoma 119 (26%), gastric adenocarcinoma 49 (11%), neuroendocrine tumor 43 (9%), hepatocarcinoma 42 (9%), cancer of the esophagus 27 (6%), cholangiocarcinoma 18 (4%), prostate cancer 12 (3%), gastric GIST 15 (3%), adenocarcinoma of the pancreas 16 (3%) and other less frequent, among these benign diseases such as liver abscess 5 (1%), nodules of regeneration 4 (0.8%) and hemangiomas 4 (0.8%).

Conclusion:

The digestive tract and its accessory glands are frequent sites of primary tumors that metastasize to the liver, therefore digestive endoscopy is justified for the investigation of cancer of unknown primary site with hepatic metastases. The findings in present study demonstrates that benign diseases can also manifest as metastases in x ray studies.

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