Biliary Tract Cancer

Question 1

What is the surgical management of muscle invasive incidental gallbladder cancer?

Answer 1

Liver bed resection and lymphadenectomy

Question 2

Which features are most suggestive of poor prognosis in resected biliary tract cancers?

Answer 2

Tumour depth and lymph node involvement

Question 3

Which chemotherapy typically given adjuvantly in ampullary cancer?

Answer 3

Gemcitabine if pancreatic type or 5FU in colorectal type

Question 4

What is the overall survival benefit with the addition durvulamab in BTC?

Answer 4

mOS 11.7m VS 8.1m

Question 5

Second line management of BTC?

Answer 5

Consider rechallenge with gem/cis if >6m DFI or FOLFOX/FOLFIRI

Question 6

Which molecular markers should be done in intrahepatic cholangiocarcinoma?

Answer 6

IDH1, FGFR2 and MMR

Question 7

What percentage of IHCCa are FGFR2 positive?

Answer 7

15%

Question 8

Which FGFR2i is licensed and in which line of treatment?

Answer 8

Pemigatinib in the second line

Question 9

Most common side effects of FGFRi?

Answer 9

Hyperphosphataemia requiring use of phosphate binders, dry eyes and mucous membranes, hair loss and diarrhoea. Need ophthalmology review prior to starting as rarely causes retinal detatchment.

Question 10

What percentage of IHCCa are IDH1 positive?

Answer 10

10-20%

Question 11

In MMRd cholangiocarcinoma what treatments are available?

Answer 11

Pembrolizumab in the second line

Question 12

What percentage of patients with gallbladder cancer have gallstones?

Answer 12

70-90%