Cholangiocarcinoma Flashcards
What is cholangiocarcinoma?
Cancer that arises in the bile ducts either within or outside the liver
Fairly poor prognosis as they are rare and symptoms are vague, with a 12-18 month survival rate.
What are the main risk factors for cholangiocarcinoma?
- Age
- Male
- Smoking
- Obesity
- Toxins (Thorotrast)
- Chronic inflammation of bile ducts
Chronic inflammation includes conditions like primary sclerosing cholangitis, liver cirrhosis, bile duct stones, parasitic liver disease, and choledochal cyst disease.
What is the pathophysiology of cholangiocarcinoma?
Risk factors and chronic inflammation increase the risk of DNA mutations, leading to cancer
Most cholangiocarcinomas arise from the biliary epithelium and are considered adenocarcinomas.
Common sites of metastasis in cholangiocarcinoma
- Metastasis: lymph, blood
- Sites of metastasis: lungs, liver, regional LN and peritoneum.
What are the types of bile duct cancer?
- Intrahepatic
- Extrahepatic
- **Perihilar bile duct cancer **
- Distal bile duct cancer
Perihilar bile duct cancer is the most common, while distal bile duct cancer occurs where the common bile duct passes through the pancreas.
What are common symptoms of cholangiocarcinoma?
- Anorexia
- Weight loss
- Fevers (20%)
- Fatigue
- Abdominal pain - RUQ
Extrahepatic cancer is often associated with symptoms indicating biliary obstruction like jaundice and pruritis.
What is Courvoisier’s law?
A painless, palpable gallbladder in a patient with jaundice is unlikely to be caused by gallstones, suggesting a more serious cause like a** tumor **in the pancreatic head or lower biliary tree
What are some other symptoms of cholangiocarcinoma which suugest biliary obstruction?
- Jaundice
- Pruritis (65%) - bile salts in the blood irritate the peripheral nervous system
- Pale-coloured stools
- Dark urine
What laboratory findings are common in cholangiocarcinoma?
- HIGH ALP (alkaline phosphatase)
- GGT
- Bilirubin
- Prolonged PT time
- Elevated CA19-9 and CEA levels
An obstructive picture is common in blood tests.
What imaging techniques are used to investigate cholangiocarcinoma?
- USS (ultrasound)
- MECP (MRI)
- ERCP (Endoscopic test)
- PTC (Percutaneous transhepatic cholangiography)
MECP provides a detailed view of the liver, bile ducts, gallbladder, and pancreas.
What are some differential diagnoses for post-hepatic jaundice?
- Pancreatic cancer
- Hepatocellular cancer
- Acute cholecystitis
- Acute hepatitis
- PSC
- Primary biliary cirrhosis
- Bile duct strictures
Tumor markers can help distinguish these conditions.
What are the surgical management options for cholangiocarcinoma?
- Removal of bile duct for small, localized cancers
- Partial hepatectomy for intrahepatic bile ducts
- Pancreaticoduodenectomy for distal bile duct cancers
Management depends on tumor location, stage, and patient’s general health.
What role does chemotherapy play in cholangiocarcinoma treatment?
Adjuvant chemotherapy or radiotherapy
Chemotherapy alone cannot cure the cancer.
What are common palliative treatments for cholangiocarcinoma?
- Stenting
- Chemotherapy/radiotherapy with Gemcitabine or Cisplatin
Palliative care is often the most common approach due to late presentation.
What are some complications related to cholangiocarcinoma?
- Biliary tract sepsis
- Secondary biliary cirrhosis
- Surgical complications (anesthetic, hemorrhage, infection)
- Specific complications (anastomotic leaks, pancreatic fistulas)
Complications can arise from both the cancer and its treatment.
What is the prognosis for cholangiocarcinoma?
Often very poor
Extrahepatic 5-year survival: 30% (localized), 2% (metastatic); Intrahepatic 5-year survival: 5% (localized).
Wat is the new target drug being used to cholangiocarcinoma?
Pemigatinib
