Cholangiocarcinoma

Question 1

What is a cholangiocarcinoma?

Answer 1

Cancer originating in the bile ducts

Question 2

What are the majority of cholangiocarcinomas?

Answer 2

Adenocarcinomas

Question 3

Where do cholangiocarcinomas affect bile ducts?

Answer 3

Inside and out the liver
(intra and extrahepatic ducts)

Most common site is the perihilar region (where left and right hepatic ducts join to become the common hepatic duct)

Question 4

What are the key risk factors for developing a cholangiocarcinoma?

Answer 4

Primary sclerosis cholangitis
10-20% chance
(Patients with ulcerative colitis are at risk of developing this)

Liver flukes
Parasitic infection
Southeast Asia and Europe

Question 5

How does a cholangiocarcinoma present?

Answer 5

Obstructive jaundice
Pale stools
Dark urine
Itching

Weight loss
RUQ pain
Painless palpable gallbladder (due to obstruction in duct distal to gallbladder)
Hepatomegaly

Question 6

What are some differential diagnoses of painless jaundice?

Answer 6

Cholangiocarcinoma
Head of pancreas cancer (more common)

Question 7

What is Courvoisier’s Law?

Answer 7

Palpable gallbladder along with jaundice unlikely to be gallstones

Cholangiocarcinoma or pancreatic cancer

Question 8

How are cholangiocarcinomas diagnosed?

Answer 8

Imaging and histology from a biopsy

Question 9

What investigations are done for cholangiocarcinomas?

Answer 9

Staging CT
Look for metastasis

CA 19-9
Carbohydrate antigen, raised in pancreatic cancer

MRCP

ERCP

Question 10

How are cholangiocarcinomas managed?

Answer 10

Curative surgery in early cases with radiotherapy and chemotherapy

Most cases not possible, palliative treatment
- Stents to relieve obstruction
- Surgery for symptoms
- Palliative chemotherapy and radiotherapy
- End of life care with symptom control