Cholangiocarcinoma Flashcards
Cholangiocarcinoma
The presence of slowly worsening jaundice alongside unexplained weight loss should raise suspicion of malignancy, including cholangiocarcinoma and pancreatic cancer.
The presence of a palpable mass in the right upper quadrant (RUQ) supports these diagnoses, as Courvoisier’s law states that a palpable mass in the RUQ is more likely to be a malignant obstruction of the common bile duct rather than obstruction due to stones.
Since this patient has ulcerative colitis (UC) and has had these symptoms for a while, with her symptoms worsening recently, it is likely that they have cholangiocarcinoma, as patients with UC can develop primary sclerosing cholangitis (PSC) which can increase the risk of cholangiocarcinoma.
Common bile duct stones
Although this can also cause jaundice and may have a right upper quadrant mass, common bile duct stones causing these symptoms are much less common than pancreatic cancer and cholangiocarcinoma.
Common bile duct stones would also not explain the weight loss this patient has experienced. NICE also recommends referring patients via a suspected cancer pathway for an urgent ultrasound if patients have an upper abdominal mass consistent with an enlarged gallbladder. Therefore, this diagnosis is less likely.
Hepatocellular carcinoma (HCC)
HCC tend to present with features of acutely worsening chronic liver disease.
The absence of signs such as ascites, asterixis, peripheral oedema, hepato- and/or splenomegaly, and a history of variceal bleeding makes HCC less likely.
Pancreatic carcinoma is incorrect. Although this can also cause jaundice, a RUQ mass, and weight loss, this patient has a history of UC. It is likely that this patient has had PSC which has led to the development of cholangiocarcinoma, as PSC increases the risk of cholangiocarcinoma. Patients with pancreatic cancer may also have epigastric or back pain which is not seen in cholangiocarcinoma.
Acute cholangitis
This presents acutely with a triad of RUQ pain, fever, and jaundice. This patient is afebrile, her symptoms have been ongoing for a while, and there is no RUQ pain. Furthermore, acute cholangitis does not explain the presence of a mass in the RUQ, which should always raise suspicion of malignancy.
