Cholangiocarcinoma Flashcards

1
Q

what is the key presentation of cholangiocarcinoma?

A

FLAWS, painless obstructive jaundice symptoms palpable gall bladder UC/PSC CA19-9

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2
Q

define cholangiocarcinoma?

A

Cholangiocarcinomas are cancers arising from the bile duct epithelium. - PRIMARY ADENOCARCINOMA OF BILIARY TREE

These can be divided depending on their location in the biliary tree: intrahepatic or extrahepatic (perihilar and distal).

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3
Q

what are the risk factors for cholangiocarcinoma?

A
  • Ulcerative colitis + primary sclerosing cholangitis
  • Choledocholithiasis + Cholecystolithiasis (stonesin bile ducts / stones in gallbladder)
  • Choledochal cyst(congenital conditions involving cystic dilatations of bile ducts)
  • Non-specific cirrhosis
  • Alcoholic liver disease
  • Caroli disease (rare genetic condition in which you get dilatation of intrahepatic bile ducts)
  • HCV/ HBV/ HIV
  • Parasitic infectionof biliary tract (liver fluke e.g. Chlonorchis sinesisand Opisthorchis viverrini)
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4
Q

summarise the epidemiology of cholangiocarcinoma?

A

VERY RARE

More common in the developing worlddue to the increased prevalence of parasitic infections

More common in men due to increased occurrence of PSCin men

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5
Q

what are the presenting symptoms of cholangiocarcinoma?

A

Obstructive jaundice symptoms

  • Yellow sclera
  • Pale stools
  • Dark urine
  • Pruritus

Abdominal pain or fullness

Systemic symptomsof malignancy: weight loss, malaise, anorexia

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6
Q

what are the signs of cholangiocarcinoma on physical examination?

A

Jaundice

Palpable gallbladder which is NON-TENDER

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 or a distended gallbladder due to to other causes other than gallstones)

Epigastric/RUQ mass

There may be hepatomegaly

May have acute cholangitis triad: fever, jaundice, RUQ pain

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7
Q

what is courvoisier’s law?

A

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 or a distended gallbladder due to to other causes other than gallstones)

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8
Q

what are the investigations for cholangiocarcinoma and interpret the results?

A

FBC

U&Es

LFTs (high ALP + GGT + bilirubin + PTT)

Clotting screen

Tumour markers

  • CEA elevated in IBD and cholangiocarcinoma (+ other tumours)
  • CA19-9 is a marker of pancreatic cancer and cholangiocarcinoma
  • CA-125– elevated in up to 65% of patients

Ultrasound – identifies malignant vs benign lesions

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9
Q

what investigations should you consider for cholangiocarcinoma?

A

Endoscopy

ERCP will allow bile cytology and tumour biopsy

CT, MRI, Bone Scan - for staging

PTC – when tumour causes complete obstruction and ERCP is unable to assess the biliary tree proximal to the tumour

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