Cancer Flashcards
Cholangiocarcinoma of Distal Bile Duct
T Staging
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
Cholangiocarcinoma
- Distal Bile Duct
N and M
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
Cholangiocarcinoma
- Distal CBD
Stage
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
Cholangiocarcinoma
-Distal CBD
OUTCOMES:
5YS: 14-40% after complete resection
Median Survival 2 years
Survival > 12 months uncommon if unresectable
Bismuth, Nakache and Diamond Classification of tumour involvement
Bismuth Type One Mx
Common duct resection
cholecystectomy
5-10mm margin of resection
Roux-en-y HJ
Bismuth 3/4 Mx
Complex resection, reconstruction of portal Vein/hepatic artery
Reconstruction to secondary biliary radicles with transanastomotic stent
Bismuth 2 Mx
CBD resection + cholecystectomy + partial liver and caudate lobe resection
Reconstruction Roux en Y hepaticojej
Cholangiocarcinoma
- Hilar (Klatskins)
Blumgart Clinical Staging T1
T1: Tumour involving biliary confluence +/- unilateral extension to second order biliary radicals
Cholangiocarcinoma
- Hilar (Klatskins)
Blumgart Clinical Staging T2
T2 Tumour involving biliary confluence +/- unilateral extension to second order biliary radicles
AND
Ipsilateral portal vein involvement +/- ipsilateral hepatic lobar atrophy
Cholangiocarcinoma
- Hilar (Klatskins)
Blumgart Clinical Staging T3
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
Perihilar Cholangiocarcinoma
AJCC TNM
Perihilar Cholangiocarcinoma
AJCC TNM Staging
Perihilar Cholangiocarcinoma Resection Prognosis
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
Perihilar Cholangiocarcinoma Resection Prognosis
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
Intrahepatic Cholangiocarcinoma TNM/AJCC
Intra-Hepatic Cholangiocarcinoma Survival
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
Gallbladder Carcinoma: AJCC
Gallbladder Carcinoma: Surgical Resection
Extent of resection is determined by involvement of major vasculature.
Unresectable if…
Distant Metastatic disease
Involvement of hepatic vasculature the precludes complete resection
Presence of disease in distant LN groups
Gallbladder Carcinoma
T1-T2 Mx
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
Gallbladder Carcinoma
T3 Mx
Hepatic resection, lorta hepatislymphadenectomy and bile duct resection if required –> right trisegmentectomy
If N1 needs lymphadenectomy
Gallbladder Carcinoma
T4 Mx
Unresectable
Gallbladder Carcinoma
Who to reintervene on if found on histopath post op…
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
Todani Classification of Choledochal cysts
