Cholangiocarcinoma

Question 1

Definition

Answer 1

Primary adenocarcinoma of the biliary tree

Question 2

Aetiology

Answer 2

Unknown

Question 3

Risk factors

Answer 3

o Ulcerative colitis + primary sclerosing cholangitis

o Choledochal cyst (congenital conditions involving cystic dilatations of bile ducts)

o Caroli disease (rare genetic condition in which you get dilatation of intrahepatic bile ducts)

o Parasitic infection of biliary tract

Question 4

Epidemiology

Answer 4

· VERY RARE

· More common in the developing world due to the increased prevalence of parasitic infections

Question 5

Presenting symptoms

Answer 5

· Obstructive jaundice symptoms
o Yellow sclera
o Pale stools
o Dark urine
o Pruritus

· Abdominal pain or fullness

· Systemic symptoms of malignancy: weight loss, malaise, anorexia

Question 6

Signs on physical examination

Answer 6

· Jaundice

· Palpable gallbladder
o NOTE: Courvoisier’s Law - in the presence of jaundice, a palpable gallbladder (that is non-tender) is unlikely to be due to gallstones (i.e. cancer of the pancreas or biliary tree is more likely)

· Epigastric/RUQ mass

· There may be hepatomegaly

Question 7

Investigations

Answer 7

· Bloods
o FBC
o U&Es
o LFTs (high ALP + GGT)
o Clotting screen
o Tumour markers
· CA19-9 is a marker of pancreatic cancer and cholangiocarcinoma

· Endoscopy
o ERCP will allow bile cytology and tumour biopsy

· Ultrasound

· CT, MRI, Bone Scan - for staging