Bile Duct Cancer

Question 1

What is the Bismuth I perihilar cholangiocarcinomas classification?

Answer 1

located distal to hepatic duct confluence

Question 2

What is the Bismuth II perihilar cholangiocarcinomas classification?

Answer 2

involve the junction of the right and left hepatic ducts

Question 3

What is the Bismuth III perihilar cholangiocarcinomas classification?

Answer 3

A) involves confluence and the right hepatic duct, B) involves the confluence of the left hepatic duct

Question 4

What is the Bismuth IV perihilar cholangiocarcinomas classification?

Answer 4

involves both the proximal left and right hepatic ducts to the segmental bile ducts

Question 5

Name some of the risk factors for cholangiocarcinomas.

Answer 5

chronic inflammation of the ducts, primary sclerosing cholangitis, bile duct cysts, Salmonella typhi infection, parasitic infections

Question 6

What are the three subtypes of cholangiocarcinomas?

Answer 6

sclerosing (more common), nodular, and papillary

Question 7

Which subtype of cholangiocarcinoma has higher resection and survival rates compared to the other two?

Answer 7

papillary tumors

Question 8

Staging by AJCC for intrahepatic cholangiocarcinoma is the same as what other malignancy?

Answer 8

hepatocellular carcinoma

Question 9

What are the contraindications to resection of intrahepatic cholangiocarcinomas?

Answer 9

extrahepatic disease, metastases in the liver, or mets within regional lymph nodes outside the hepatoduodenal ligament

Question 10

What should be done if the future liver remnant (based on liver volumes) is too small in preoperative workup?

Answer 10

portal vein embolization of the affected liver

Question 11

What is the 5-year survival rate for patients undergoing R0 resection of intrahepatic cholangiocarcinoma?

Answer 11

30-40%

Question 12

What are the boundaries of cholangiocarcinoma involvement in the CBD which mandate pancreaticoduodenectomy?

Answer 12

superior border of the pancreas to the ampulla of vater

Question 13

What is the 5-year survival rate for patients following resection of distal cholangiocarcinoma?

Answer 13

15-40%

Question 14

What chemotherapy regimen is appropriate for cholangiocarcinoma metastatic disease?

Answer 14

gemcitabine-based

Question 15

Describe perihilar cholangiocarcinoma T1 stage?

Answer 15

tumor involving biliary confluence +/- unilateral extension to the secondary biliary radicles

Question 16

Describe perihilar cholangiocarcinoma T2 stage?

Answer 16

T1 tumors + ipsilateral portal vein involvement +/- ipsilateral hepatic lobar atrophy

Question 17

Describe perihilar cholangiocarcinoma T3 stage?

Answer 17

T1 + bilateral extension to secondary biliary radicals or contralateral PV involvement or heaptic lobar atrophy

Question 18

Should a patient with perihilar cholangiocarcinoma, who is healthy with reserctable disease and a total bilirubin <10 have preoperative biliary decompression?

Answer 18

No

Question 19

Under what circumstances is pre-operative biliary decompression/stenting indicated?

Answer 19

when noninvasive cholagniogram is inadequate for preop planning, when PV embolization is necessary, bilirubin >10, unfit/malnourished pt requring preop optimaiation

Question 20

Where do segment I ducts drain?

Answer 20

into the confluence of the right and left ducts

Question 21

True/False. If an en-bloc segmental portal vein resection is required to achieve R0 resection of perihilar cholangiocarcinoma, this is a contraindication to reserction.

Answer 21

FALSE

Question 22

What is the 5-year survival for patients with perihilar cholangiocarcinoma?

Answer 22

25-40%

Question 23

What is photodynamic therapy and in what patient population is it used?

Answer 23

iV administration of porphyrin then light activation via cholangioscopy results in release of reactive oxygen species and cell destruction of tumor cells; indicated in locally unresectable patients without metastases