Cholangiocarcinoma Flashcards
What is cholangiocarcinoma?
It is defined as a primary liver cancer that originates in the bile ducts - usually the extra hepatic biliary tree
What is the function of the bile ducts?
To carry bile from the liver into the gallbladder and then small intestine
How common is cholangiocarcinoma?
It is the second most common type of primary liver malignancy
What are the seven risk factors of cholangiocarcinoma?
Primary Sclerosing Cholangitis
Typhoid Fever
Liver Flukes
Choledochal Cysts
Chronic Liver Disease
Diabetes Mellitus
Smoking
What is the main risk factor associated with cholangiocarcinoma?
Primary Sclerosing Cholangitis
What are the seven clinical features of cholangiocarcinoma?
Courvoisier Sign
Painless Jaundice
Pale Stools
Nausea & Vomiting
Pruritis
Weight Loss
Lymphadenopathy
What is the main clinical feature of cholangiocarcinoma?
Courvoisier sign
What is Courvoisier’s sign?
It is defined as a palpable mass in the right upper quadrant
What is a late clincial feature of cholangiocarcinoma, in which the majority of disease is not resectable?
Painless Jaundice
What two lymphadenopathies are associated with cholangiocarcinoma?
Virchow’s node
Sister Mary Joseph node
What is Virchow’s node?
It is the lymph node present in the left supraclavicular region
What is Sister Mary Joseph’s node?
It is the lymph node present in the periumbillical region
Which five investigations are used to diagnose cholangiocarcinoma?
Blood Tests
Urinalysis
Ultrasound Scan
CT/MRI Scans
Endoscopic Retrograde Cholangiopancreatography (ERCP)
What eight blood test results indicate cholangiocarcinoma?
Increased CA19-9 Levels
Increased CEA Levels
Increased CA 125 Levels
Increased ALT Levels
Increased AST Levels
Increased ALP Levels
Increased Gamma GT Levels
Increased Bilirubin Levels
What three tumour markers are associated with cholangiocarcinoma?
CA19-9
CEA
CA 125
What is the main tumour marker is associated with cholangiocarcinoma?
CA19-9
What is the feature of cholangiocarcinoma on urinalysis?
High levels of conjugated bilirubin
What is the feature of cholangiocarcinoma on ultrasound scans?
Hypoechoic lesion
How are CT/MRI scans used to diagnose cholangiocarcinoma?
They are used to confirm the findings established on ultrasound and to determine the staging
What is ERCP?
It involves the insertion of an endoscope through the oesophagus, stomach and into the duodenum
In the duodenum, the endoscope is then guided through the sphincter of Oddi into the bile duct – where contrast is injected, and x-rays are then taken
What is the gold standard investigation used to diagnose cholangiocarcinoma?
ERCP
How is ERCP used to diagnose cholangiocarcinoma?
Brushings for cytology
OR
Biopsies for histopathological diagnosis
What are the two surgical management options used in cholangiocarcinoma?
Liver Resection
Endoscopic Retrograde Cholangiopancreatography (ERCP)
What is liver resection?
It involves surgical removal of the section of liver affected by malignancy
When is liver resection used to manage cholangiocarcinoma?
It can be used as a curative measure in early disease confined to liver
In which two circumstances is liver resection contraindicated?
Local invasion of peri-hilar nodes
Lobar atrophy
How is ERCP used to manage cholangiocarcinoma?
It can be used to insert a sent into the bile duct to relieve compression caused by cholangiocarcinoma
This enables drainage of bile and therefore symptomatic relief
In cholangiocarcinoma, can chemotherapy and radiation be used as a management option?
No - it is generally considered resistant to chemotherapy and radiotherapy
In certain circumstances, it can be used in a palliative setting
