Biliary Tract and Gallbladder Cancer Flashcards
What percentage of cholangiocarcinoma is intrahepatic? Perihilar? Distal extra hepatic?
5% - intrahepatic
65% - perihilar
30% - distal extrahepatic
What is the typical age at diagnosis of cholangiocarcinoma?
50-70
*earlier if PSC and biliary cuts
What are some risk factors for cholangiocarcinoma?
PSC
Biliary cysts
Biliary parasitosis (Clonorchis and Opisthorchis)
Thorotrast
What do 70-80% of patients with primary sclerosing cholangitis have?
IBS – ulcerative colitis
What is the typical appearance of PSC on histology?
“onion skinning” around bile ducts
Biliary cyst: Type I
50-85%
Exttrahepatic only
Biliary cyst: Type IV
15-35%
Multiple cysts
Extrahepatic +/- intrahepatic
Biliary cyst: Type V
20%
Intrahepatic only
Caroli’s disease
What types of biliary cysts predispose to cholangiocarcinoma?
Types I, II and IV
What chronic parasite infections are associated with development wolf cholangiocarcinoma?
Clonorchis sinesis
Opisthorchiasis
What is it called when you get cholangiocarcinoma at the bifurcation of bile ducts?
Klatskin tumor – patient will have jaundice, direct bilirubin will be elevated
The majority of cholangiocarcinomas are…
Adenocarcinoma (90%)
Squamous cell carcinoma and others
How will extrahepatic cholangiocarcinoma present versus intrahepatic cholangiocarcinoma?
Extrahepatic – get symptoms from biliary obstruction (jaundice, abdominal pain, pruritus, weight loss, fever; cholestatic liver test elevations
Intrahepatic – less likely to be jaundiced, abdominal pain, weight loss
What are some diagnostics available for cholangiocarcinoma?
Carbonic anhydrase 19-9: limited value d/t false positives and negatives
Computed tomography
MRI
Endoscopic retrograde cholangio pancreatigraphy (ERCP) –noninvasive
What is the treatment for cholangiocarcinoma?
Curative treatment = surgery
Liver transplant for hilar cholangiocarcinoma
Palliative = 5-10% 5 year survival
Curative surgeries for different locations of cholangiocarcinoma…
Distal = Whipple procedure Perihilar = bile duct resection, hepatic lobectomy Intrahepatic = hepatic resection
What is the most common type of gall bladder cancer?
Adenocarcinoma – 75% of cases
Uncommon and highly fatal
Women affected 2-6 times more than men
Risk factors for gall bladder cancer
Porcelain gallbladder – incomplete calcification higher risk than complete calcification
Gallbladder polyps
Cholelithiasis (70-90% of patients with gallbladder cancer have cholelithiasis)
How does one get a porelain gallbladder?
Chronic cholecystitis with intramural calcification of the gallbladder wall
What are some types of gallbladder polyps?
Cholesterol
Inflammatory
Adenomas
*Likelihood of malignant transformation related to size
What is the best diagnostic tool for the gallbladder and bile ducts?
Ultrasound
What are the 4 ways gallbladder cancer typically presents?
- Incidental on imaging
- Found intraoperatively during cholecystectomy for presumed benign disease
- Found incidentally on pathologic examination (most common)
- Symptomatic: pain, anorexia, nausea, vomiting, jaundice from biliary obstruction
What is the treatment for gallbladder cancer?
Surgery is the only option for cure
Advanced stage at diagnosis – poor prognosis
Can spread to other structures it is in close proximity with
