Chapter 53: Biliary Tract- Cholangiocarcinoma Flashcards
What is it?
Malignancy of the extrahepatic or intrahepatic ducts—primary bile duct cancer
What is the histology?
Almost all are adenocarcinomas
Average age at diagnosis?
≈65 years, equally affects male/female
What are the signs and symptoms?
Those of biliary obstruction: jaundice, pruritus, dark urine, clay-colored stools,cholangitis
What is the most common location?
Proximal bile duct
What are the risk factors?
- Choledochal cysts
- Ulcerative colitis
- Thorotrast contrast dye (used in 1950s)
- Sclerosing cholangitis
- Liver flukes (clonorchiasis)
- Toxin exposures (e.g., Agent Orange)
What is a Klatskin tumor?
Tumor that involves the junction of the right and left hepatic ducts
What are the diagnostic tests of choice?
Ultrasound, CT scan, ERCP/PTC with biopsy/brushings for cytology, MRCP
What is an MRCP?
MRI with visualization of pancreatic and bile ducts
What is the management of proximal bile duct cholangiocarcinoma?
Resection with Roux-en-Y hepaticojejunostomy (anastomose bile ducts to jejunum) ± unilateral hepatic lobectomy
What is the management of distal common bile duct cholangiocarcinoma?
Whipple procedure