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Biliary Tree > Cancer > Flashcards

Cancer Flashcards

1
Q

Cholangiocarcinoma of Distal Bile Duct

T Staging

A

TX: Primary tumour cannot be assessed
T0: No evidence of primary tumours
Tis: Carcinoma in Situ
T1: Tumour confined to the bile duct histologically
T2: Tumour invades beyond the wall of the bile duct
T3: Tumour invades the gallbladder, pancreas, duodenum or other organs without involvement of the coeliac axis or SMA
T4: involve SMA/coeliac Axis

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2
Q

Cholangiocarcinoma
- Distal Bile Duct

N and M

A

NX: regional lymph nodes cannot be assessed
N0: No regional Lymph nodes metastasis
N1: Regional Lymph Node Metastasis

M0: NO DISTANT METS
M1: Distant Mets

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3
Q

Cholangiocarcinoma
- Distal CBD
Stage

A 
Stage 0: TisN0M0
Stage 1A: T1N0M0
Stage 1B: T2N0M0
Stage IIA: T3N0M0
Stage IIB: T1-3N1M0
Stage III: T4, any N, M0
Stage IV any T, any N, M1
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4
Q

Cholangiocarcinoma
-Distal CBD

OUTCOMES:

A

5YS: 14-40% after complete resection
Median Survival 2 years
Survival > 12 months uncommon if unresectable

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5
Q

Bismuth, Nakache and Diamond Classification of tumour involvement

A
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6
Q

Bismuth Type One Mx

A

Common duct resection
cholecystectomy
5-10mm margin of resection
Roux-en-y HJ

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7
Q

Bismuth 3/4 Mx

A

Complex resection, reconstruction of portal Vein/hepatic artery

Reconstruction to secondary biliary radicles with transanastomotic stent

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8
Q

Bismuth 2 Mx

A

CBD resection + cholecystectomy + partial liver and caudate lobe resection

Reconstruction Roux en Y hepaticojej

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9
Q

Cholangiocarcinoma
- Hilar (Klatskins)
Blumgart Clinical Staging T1

A

T1: Tumour involving biliary confluence +/- unilateral extension to second order biliary radicals

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10
Q

Cholangiocarcinoma
- Hilar (Klatskins)
Blumgart Clinical Staging T2

A

T2 Tumour involving biliary confluence +/- unilateral extension to second order biliary radicles
AND
Ipsilateral portal vein involvement +/- ipsilateral hepatic lobar atrophy

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11
Q

Cholangiocarcinoma
- Hilar (Klatskins)
Blumgart Clinical Staging T3

A

T3: Tumour involving biliary confluence + bilateral extension into second order radicles
OR unilateral extension into second order radicles and contralateral portal vein involvement
OR unilateral extension to second order biliary radicle with contralateral hepatic lobar atrophy
OR main or bilateral portal venous involvement

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12
Q

Perihilar Cholangiocarcinoma

AJCC TNM

A
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13
Q

Perihilar Cholangiocarcinoma

AJCC TNM Staging

A
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14
Q

Perihilar Cholangiocarcinoma Resection Prognosis

A

Complete R0 resection - 43 month median survival
5YR survival 20-40%

R1/R2 resection doesn’t improve survival over unresectable tumours (24 month median survival

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15
Q

Perihilar Cholangiocarcinoma Resection Prognosis

A

Complete R0 resection - 43 month median survival
5YR survival 20-40%

R1/R2 resection doesn’t improve survival over unresectable tumours (24 month median survival

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16
Q

Intrahepatic Cholangiocarcinoma TNM/AJCC

A
17
Q

Intra-Hepatic Cholangiocarcinoma Survival

A

Median survival after resection is 36 months
9 months if unresectable
5YR survival is 20-40%
Recurrence is common: RF tumour >5cm, mulitple liver tumours and regional LN mets

18
Q

Gallbladder Carcinoma: AJCC

A
19
Q

Gallbladder Carcinoma: Surgical Resection
Extent of resection is determined by involvement of major vasculature.
Unresectable if…

A

Distant Metastatic disease
Involvement of hepatic vasculature the precludes complete resection
Presence of disease in distant LN groups

20
Q

Gallbladder Carcinoma

T1-T2 Mx

A

Consider extended cholecystectomy vs radical procedure with aggressive resection with removal of the liver, lymphadenectomy, hepatiduodenal ligament and bile duct as necessary
Central IVb/V liver resection OR right trisegmentectomy
T1a 85-100% cure rate

21
Q

Gallbladder Carcinoma

T3 Mx

A

Hepatic resection, lorta hepatislymphadenectomy and bile duct resection if required –> right trisegmentectomy

If N1 needs lymphadenectomy

22
Q

Gallbladder Carcinoma

T4 Mx

A

Unresectable

23
Q

Gallbladder Carcinoma

Who to reintervene on if found on histopath post op…

A

T1b-3
T1a (lamina propria) : no re-resection
T1b (muscular layer): 42%–>100% 5yr survival
T2 (perimuscular on CT): 0–>78% 5yr survival
T3 (liver or serosa, single organ): 0-25% 5yr survival
T4 (MainPV/HA, multiorgan: highly selective pt
N1 - up to 25% 5yr survival if Ro resection achieved
N2/M1 - No Benefit 0% 5YS

24
Q

Todani Classification of Choledochal cysts

A
25
Q

Extrahepatic Cholangiocarcinoma

Histological Subtypes

A
  1. Nodular-sclerosing
  2. Papillary (less common – 10%)
    - Mainly extrahepatic
    - Typically expansile growing intraluminally rather than transmurally
    - Stalk, mobile within lumen
    - More often resectable

Best prognosis with well-differentiated papillary tumours

26
Q

Intrahepatic Cholangiocarcinoma

Histological subtypes

A

Mass forming type
Periductal Infiltrating type
Intraductal growth type

Biliary Tree (2 decks)

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