Bile Duct Cancer Flashcards

1
Q

What is the Bismuth I perihilar cholangiocarcinomas classification?

A

located distal to hepatic duct confluence

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2
Q

What is the Bismuth II perihilar cholangiocarcinomas classification?

A

involve the junction of the right and left hepatic ducts

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3
Q

What is the Bismuth III perihilar cholangiocarcinomas classification?

A

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

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4
Q

What is the Bismuth IV perihilar cholangiocarcinomas classification?

A

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

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5
Q

Name some of the risk factors for cholangiocarcinomas.

A

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

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6
Q

What are the three subtypes of cholangiocarcinomas?

A

sclerosing (more common), nodular, and papillary

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7
Q

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

A

papillary tumors

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8
Q

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

A

hepatocellular carcinoma

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9
Q

What are the contraindications to resection of intrahepatic cholangiocarcinomas?

A

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

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10
Q

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

A

portal vein embolization of the affected liver

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11
Q

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

A

30-40%

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12
Q

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

A

superior border of the pancreas to the ampulla of vater

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13
Q

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

A

15-40%

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14
Q

What chemotherapy regimen is appropriate for cholangiocarcinoma metastatic disease?

A

gemcitabine-based

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15
Q

Describe perihilar cholangiocarcinoma T1 stage?

A

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

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16
Q

Describe perihilar cholangiocarcinoma T2 stage?

A

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

17
Q

Describe perihilar cholangiocarcinoma T3 stage?

A

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

18
Q

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

A

No

19
Q

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

A

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

20
Q

Where do segment I ducts drain?

A

into the confluence of the right and left ducts

21
Q

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.

A

FALSE

22
Q

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

A

25-40%

23
Q

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

A

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