Cholangiocarcinoma (1)

Question 1

What is its most common type?

Where does it commonly form?

What are its risk factors?

Answer 1

➊ Adenocarcinoma

➋ At the perihilar region of the liver (where both hepatic ducts join to form the common hepatic duct)

➌ • Primary Sclerosing Cholangitis (risk with UC)
• Liver flukes (parasitic infection)

Question 2

How does it present?

What will be found O/E?

Answer 2

➊ Painless obstructive jaundice - dark urine, pale stools, itchiness

➋ Palpable gallbladder

N.B. Courvoisier’s Law - Palpable gallbladder + jaundice is unlikely to be due to gallstones, and is usually cholangiocarcinoma/pancreatic ca.

Question 3

Which investigations should be done?

How is it managed?

Answer 3

➊ Same as for pancreatic ca.:
• Abdomen USS - Good at detecting tumours at head, but not body/tail so a -ve result doesn’t rule out ca.
• CT
• CA19-9
• MRCP/ERCP

➋ • Most present too late for curative surgery to be an option
• Palliative - Stents, Chemo/radiotherapy, EOL care w/symptom control