Background Flashcards
What are the 3 anatomic subtypes of biliary cancer (CC)?
CC is grouped into intrahepatic (10%), perihilar/Klatskin (60%), and extrahepatic (30%) subtypes. Klatskin tumors involve the hepatic duct bifurcation.
How is GB cancer distinct from CC?
GB cancer has unique epidemiology, presentation, staging, and surgical Tx.
What are major risk factors for CC?
Primary sclerosing cholangitis, liver flukes (especially in Southeast Asia), and choledochal cysts increase the risk for CC by causing bile duct inflammation.
What is the major risk factor for GB cancer?
Cholelithiasis increases the risk for GB cancer (presumably via chronic inflammation).
What is the annual incidence/mortality of CC and GB cancer in the United States?
There are ∼11,000/yr new cases of CC and GB cancer in the United States and ∼3,600/yr deaths.
What is the histology of most CC and GB cancer?
Most CC and GB cancers are adenocarcinomas. They are difficult to distinguish from pancreatic adenocarcinoma on histopathology alone.
What less common path subtype of GB cancer and CC has a better prognosis?
Papillary adenocarcinoma is associated with improved prognosis compared to other adenocarcinomas of the biliary tree and GB.
What are the incidence and major sites of DM for CC and GB cancer?
30%–50% of CC and 40%–50% of GB cancer present with DM, most commonly to liver, peritoneum, and lung.
What is the MS for unresectable or metastatic Dz?
MS is <6 mos for unresectable or metastatic CC and GB cancer.
What is the incidence of LN mets in resectable CC and GB cancer?
30%–50% of hilar and extrahepatic cholangiocarcinoma (EHCC) have LN mets at resection, but lower for intrahepatic cholangiocarcinoma (IHCC). 40%–50% of GB cancer have LN mets at resection.
What is the LN drainage for hilar or EHCC?
Pericholedochal → portal vein LNs → common hepatic artery LNs → pancreaticoduodenal LNs → celiac axis/SMA LNs → aortocaval LNs. Drainage does not ascend toward hepatic hilum.
How are LN mets different for IHCC?
IHCC has a lower rate of LN mets than hilar or EHCC.
What is the most common route of spread for GB cancer and CC?
GB cancer and CC most commonly spread by direct extension (to the liver for GB cancer and along the biliary tree for CC).
What is the most common presenting Sx for CC? GB cancer?
Painless jaundice is the most common presenting Sx of CC. Biliary colic and chronic cholecystitis are the most common presenting Sx of GB cancer.
How is GB cancer most commonly diagnosed?
GB cancer is most often incidentally diagnosed at cholecystectomy for presumed benign Dz.
