Cholangiocarcinoma

Question 1

Frequency of Cholangiocarcinoma

Answer 1

2nd most common liver tumor

Question 2

3 types (localisation) of Cholangiocarcinoma

Answer 2

• intrahepatic (small biliary ducts)
• central
  
  • Klatskin tumor (at convergence of left and right hepatic duct)
• extrahepatic

Question 3

Histologic type for Cholangiocarcinoma

Answer 3

95% are adenocarcinomas

Question 4

Risk factors for Cholangiocarcinoma

Answer 4

Chronic biliary disease

• intrahepatic cholelithiasis
• primary sclerosing cholangitis

Seldom in relationship with cirrhosis or hepatitis

Question 5

Cholangiocarcinoma diagnosed at which stage

Answer 5

in most cases late
therefore 5y survival rate :
40% for intra-hepatic
20% for extra-hepatic

Question 6

Signs for cholangiocarcinoma (lab and clinic)

Answer 6

Liver and cholestatic parameters
Icterus, pruritus
Weight loss
Loss of appetite
Elevated CA19-9 (also elevated in cholangitis, etc)

Question 7

Diagnostic

Answer 7

Ultrasound

• evaluate for obstruction
• tumor extension
• bad to evaluate for distant metastasis

CT for distant metastasis
All in One MRI

Most important : anatomy of biliary anatomy proximal from obstruction (ERCP bad at that)

Question 8

Surgical therapy

Answer 8

Extended hemihepatectomy
+ resection of extrahepatic biliary ducts
+ lymph node excision
+/- pancreaticoduodenectomy

Distal to cystic duct : + whipple procedure

No OLT because of high recurrence rate

Question 9

Palliative

Answer 9

Stents
+ Brachytherapy or Chemotherapy
+ ATB to prevent cholangitis