Cholangiocarcinoma (CCA) Audit Project 

Overview 

Cholangiocarcinoma (CCA) is a rare but aggressive form of liver cancer with increasing incidence worldwide. In the UK, around 3,100 people are diagnosed each year, but outcomes remain poor, with some of the lowest survival rates of all cancers. 

Previous national analyses have identified significant variation in how patients are diagnosed and treated across England. Many patients do not receive active treatment, and the reasons for this are not fully understood. 

The Cholangiocarcinoma (CCA) Audit Project aims to better understand how CCA is managed across the NHS, starting with a national survey to map services, pathways and clinical practice. This will be followed by a patient-level audit to provide more detailed insights into patient pathways and outcomes. 

Further detail 

The first phase of the project is a survey of Hepatobiliary (HPB) units in NHS organisations across the UK. This survey will capture how CCA services are delivered, including: 

• Surgical Activity and Patient Management 

• Variation in service provision across centres, including staffing 

• Follow-up protocols 

The organisational survey will run from May to June, with publication of the results anticipated later in 2026. 

Findings from this phase will help identify variation across HPB units and inform future improvements in service delivery. 

The second phase of the project, a patient-level audit, will commence in autumn 2026 and will look at all patients diagnosed with CCA in England in 2024. Around 3000 cases will be reviewed, with data collected on the NHS National Disease Registration Service Clinical Audit System. Health Data Insight (HDI) has used this platform to manage several similar projects, including the Post Imaging Pancreatic Cancer audit, Post Endoscopy Upper Gastrointestinal Cancer project and Post Colonoscopy Colorectal Cancer audit. 

Timeline 

2026 – 2027 

• Organisational survey: May 2026  

• Patient-level audit: planned autumn 2026 

Desired outcomes 

The project will generate national insights into how CCA is managed across the NHS and identify opportunities to improve patient care. 

Findings will: 

• Highlight variation in service provision and clinical pathways  

• Support implementation of current guidelines, including BSG recommendations  

• Help identify barriers to diagnosis and treatment  

• Inform future NHS service planning and improvement initiatives  

Results will be shared through publications, conference presentations, and professional networks, as well as via HDI, NHS and partner organisation channels. 

The project will also work closely with patient and public involvement (PPI) partners, including AMMF, to ensure patient perspectives are embedded throughout. 

Project partners 

This project is managed by HDI and funded by AMMF – The Cholangiocarcinoma Charity. 

The project is led by Professor Dhanny Gomez (Nottingham University Hospitals NHS Trust), working in collaboration with: 

• AMMF – The Cholangiocarcinoma Charity (Helen Morement, Paul Howard) 

• Imperial College (Shahid Khan), University College London (John Bridgewater), NHS University Hospitals of Liverpool Group (Hassan Malik)   

• British Society of Gastroenterology (BSG)  

• Cholangiocarcinoma UK (an affiliate of the British Association for Study of Liver Disease (BASL)) 

• NHS clinical and academic partners across the UK 

Contact 

For more information about the CCA Audit Project, please contact: england.cca.audit@nhs.net