Bile Duct Cancer Flashcards
What is the Bismuth I perihilar cholangiocarcinomas classification?
located distal to hepatic duct confluence
What is the Bismuth II perihilar cholangiocarcinomas classification?
involve the junction of the right and left hepatic ducts
What is the Bismuth III perihilar cholangiocarcinomas classification?
A) involves confluence and the right hepatic duct, B) involves the confluence of the left hepatic duct
What is the Bismuth IV perihilar cholangiocarcinomas classification?
involves both the proximal left and right hepatic ducts to the segmental bile ducts
Name some of the risk factors for cholangiocarcinomas.
chronic inflammation of the ducts, primary sclerosing cholangitis, bile duct cysts, Salmonella typhi infection, parasitic infections
What are the three subtypes of cholangiocarcinomas?
sclerosing (more common), nodular, and papillary
Which subtype of cholangiocarcinoma has higher resection and survival rates compared to the other two?
papillary tumors
Staging by AJCC for intrahepatic cholangiocarcinoma is the same as what other malignancy?
hepatocellular carcinoma
What are the contraindications to resection of intrahepatic cholangiocarcinomas?
extrahepatic disease, metastases in the liver, or mets within regional lymph nodes outside the hepatoduodenal ligament
What should be done if the future liver remnant (based on liver volumes) is too small in preoperative workup?
portal vein embolization of the affected liver
What is the 5-year survival rate for patients undergoing R0 resection of intrahepatic cholangiocarcinoma?
30-40%
What are the boundaries of cholangiocarcinoma involvement in the CBD which mandate pancreaticoduodenectomy?
superior border of the pancreas to the ampulla of vater
What is the 5-year survival rate for patients following resection of distal cholangiocarcinoma?
15-40%
What chemotherapy regimen is appropriate for cholangiocarcinoma metastatic disease?
gemcitabine-based
Describe perihilar cholangiocarcinoma T1 stage?
tumor involving biliary confluence +/- unilateral extension to the secondary biliary radicles