Biliary Tract and GB Cancer Flashcards
- Cholangiocarcinomas account for approximately____ of gastrointestinal malignancies
- Typical age of diagnosis: _____
3%
50-70
What would cause ealier onset of cholangiocarcinoma then 50-70?
earlier in Primary Sclerosing Cholangitis (PSC ) and biliary cysts
Cholangiocarcinoma risk factors
- PSC (up to 30% of patients with cholangiocarcinomas)
- biliary cysts
- biliary parasitosis (Clonorchis and Opisthorchis)
- thorotrast
How do you diagnose PSC?
Need to to holiangiography to enter the GB and see if there is blockage; don’t have healthy looking biliary tree
PSC are fibrotic strictures, they are benign
What does primary sclerosing cholangitis look like on histology
Scar tissue forms around and obstructs the lumen; get onion skinning
Biliary Cysts:
- Type I: 50-85%
- ______ only
Extrahepatic
- Type _____
- Multiple cysts
- Extrahepatic +/- intrahepatic
IV: 15-35%
- Type _____
- Intrahepatic only
- Caroli’s disease
V: 20%
Clonorchis sinensis (Chinese liver fluke)
• Far East and far eastern Russia
• Asymptomatic, cholangitis
• Chronic infection associated with cholangiocarcinoma
• Treatment with anti-helminthic therapy
BILIARY PARASITOSIS
BILIARY PARASITOSIS
•________ (liver fluke of cats, dogs, and fish-eating mammals)
Southeast Asia and in Central and Eastern Europe
Similar presentation as Clonorchis sinensis
Opisthorchiasis
What types of biliary cysts predispose you to cholangiocarcinoma?
Type I, II, IV
leads to obstruction or severe narrowing of bile duct
See elevated conjugated bilirubin
Type of malignancy
Cholangiocarcinoma
(PSC is benign stricture)
When looking at histology of cholangiocarcinoma, what type is most common?
- Adenocarcinoma (> 90%)
- Squamous cell carcinoma and others
Preceptor tells you your patient has cholangiocarcinoma with the following symptoms;
Jaundice, abdominal pain, pruritus, weight loss, fever
Where is the location of the stricture?
What do the labs look like?
• Extrahepatic: symptomatic from biliary obstruction
more likely labs to be elevated than if intrahepatic
Pt has cholangiocarcinoma and presents with abdominal pain and weight loss but no jaundice, where is the cancer?
Intrahepatic
CHOLANGIOCARCINOMA: DIAGNOSIS
• Lab testing
_________ of limited valuedue to false positives and negatives
Carbonic Anhydrase (CA) 19-9
What imaging do we get to diagnose cholangiocarcinoma?
• Imaging
Computed tomography (CT)
Magnetic resonance imaging (MRI)
Endoscopic Retrograde Cholangio Pancreatigraphy (ERCP); MOST IMPORTANT
What is the treatement of Cholangiocarcinoma
Curative surgery like Whipple, perihiliar, intrahilar
OR
liver translpant for hilar cholangiocarcinoma
5% 5 yr survival if you do nothing
Describe Whipple procedure
Resect piece of bile duct
piece of pancrease
piece of small intesting and liver
Attach pancrease to jejunum and bypass duodenum
Most common GB cancer in US
who is more at risk, men or women?
- Adenocarcinoma; 75% of cases
- Uncommon (< 5,000 cases/year in the United States) and highly fatal
- Women affected 2-6 times more than men
What are risks for GB cancer?
• Porcelain gallbladder
• Gallbladder polyps
• Cholelithiasis
0.5-3% incidence
70-90% of patients with gallbladder cancer
have cholelithiasis
Chronic cholecystitis with intramural
calcification of the gallbladder wall
PORCELAIN GALLBLADDER
risk factor for GB cancer
Porcelain GB:
Is this common? geneder preferance? Affect rate of GB cancer?
uncommon, more in females (6:1)
• Increased risk of gallbladder cancer (0-62%)
Incomplete calcification of gallbladder wall associated with higher risk than complete calcification
