Biliary Tree Malignancy Flashcards
What is cholangiocarcinoma?
Malignancy of the biliary tree, affecting extra- or intra-hepatic bile ducts
Klatskin tumor refers to peri-hilar cholangiocarcinoma.
What is the epidemiology of cholangiocarcinoma?
1 in 100,000, more common in males than females, primarily affects elderly individuals (60-80 years old)
List some risk factors for cholangiocarcinoma.
- Elderly
- Disease of biliary tree (e.g., choledochal cyst, primary sclerosing cholangitis)
- Gallstones and chronic intrahepatic stones
- Iatrogenic factors (e.g., ERCP + sphincterotomy)
- Carcinogens
- Hereditary factors (e.g., HNPCC, multiple biliary papillomatosis)
What is the most common type of carcinoma found in cholangiocarcinoma? And what are the others?
Adenocarcinoma (90%) - sclerosing 95%, nodular, papillary. Squamous cell carcinoma (10%).
Define Klatskin tumor.
Peri-hilar cholangiocarcinoma
What are the stages of Klatskin tumors according to the Bismuth-Corlette classification?
- Type 1: Below confluence of left and right hepatic ducts
- Type 2: At confluence
- Type 3: Occluding common hepatic duct (A - left hepatic duct; B - right hepatic duct)
- Type 4: Multicentric
What are common characteristics of cholangiocarcinoma?
- Slow growing
- High rate of local invasion
- Distant metastases uncommon
- Mucin production
- Tends to spread along nerves
- Longitudinal spread along submucosal plane of duct
What are the early signs of cholangiocarcinoma?
Non-specific abdominal pain, biliary obstruction (jaundice, pruritus, dark urine, pale stools)
What is Courvoisier’s sign?
Palpable, non-tender distended gallbladder due to common bile duct obstruction
What tumor markers are associated with cholangiocarcinoma?
- Ca 19.9
- CEA
- AFP (HCC)
What imaging techniques are used for cholangiocarcinoma investigation?
- US
- CT
- CTA
- MRI/MRCP
- ERCP or PTC
- CXR/PET scan
What is the prognosis for cholangiocarcinoma?
Overall 5-year survival is 15%; survival <6 months if untreated
What is the primary management strategy for resectable cholangiocarcinoma?
Wide excision margin, including resection of the extra-hepatic biliary tree and porta hepatis lymphadenectomy; lack of metastasis. Aim R0 resection.
Fill in the blank: The most common presentation of cholangiocarcinoma is _______.
Painless obstructive jaundice
What is gallbladder carcinoma?
Carcinoma of the gallbladder arising from the mucosa
What is the epidemiology of gallbladder carcinoma?
1 in 100,000, more common in females (3:1), primarily affects elderly individuals
List some risk factors for gallbladder carcinoma.
- Old age
- Female gender
- Gallbladder polyps
- Chronic gallbladder inflammation
- Cholelithiasis
- Porcelain gallbladder
- Chronic infections (e.g., Salmonella, Helicobacter)
- Cholecystoenteric fistula
- Abnormal pancreaticobiliary duct junction
What is porcelain gallbladder?
An uncommon manifestation of chronic cholecystitis characterized by intramural calcification of the gallbladder wall
What types of carcinoma can arise in the gallbladder?
- Adenocarcinoma (majority)
- Squamous cell carcinoma
- Adenosquamous carcinoma
How does gallbladder carcinoma typically spread?
- Local extension to liver, stomach, duodenum
- Metastasis to liver, lung, bone
What is a common symptom of gallbladder carcinoma?
Non-specific RUQ pain
What imaging techniques are used for gallbladder carcinoma investigation?
- US
- CT/MRCP
- Endoscopic US (EUS)
- Diagnostic laparoscopy
What is the primary management for operable gallbladder carcinoma?
Surgery is the only chance of complete cure
Fill in the blank: Most recurrences of gallbladder carcinoma are due to _______.
Distant metastases
