Cholangiocarcinoma

Question 1

Cholangiocarcinoma definition

Answer 1

biliary tree cancer - arises from bile duct epithelium and can be intra or extrahepatic

Question 2

Cholangiocarcinoma risk factors

Answer 2

• age over 50
• cholangitis, especially primary sclerosing cholangitis
• other bile duct disease

Question 3

Cholangiocarcinoma pathophysiology

Answer 3

• more than 95% adenocarcinoma
• infiltrating nodular or diffusely infiltrating

Question 4

Cholangiocarcinoma signs and symptoms

Answer 4

• persistent biliary colic symptoms
• anorexia, jaundice, weight loss
• palpable RUQ mass
• Sister Mary Joseph node (periumbilical lymph node) and Virchow’s node (left supra-clavicular node)

Question 5

Cholangiocarcinoma investigations

Answer 5

• LFTs
• Ca19-9 (useful in PSC patients)
• CEA and Ca-125
• abdominal ultrasound (not sensitive)
• abdominal CT or MRI

Question 6

Cholangiocarcinoma management

Answer 6

• surgery if resectable
• if unresectable, liver transplant and chemo/radiotherapy
• palliation if extensive disease