Cholangiocarcinoma Flashcards
what is the key presentation of cholangiocarcinoma?
FLAWS, painless obstructive jaundice symptoms palpable gall bladder UC/PSC CA19-9
define cholangiocarcinoma?
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).
what are the risk factors for cholangiocarcinoma?
- 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)
summarise the epidemiology of cholangiocarcinoma?
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
what are the presenting symptoms of cholangiocarcinoma?
Obstructive jaundice symptoms
- Yellow sclera
- Pale stools
- Dark urine
- Pruritus
Abdominal pain or fullness
Systemic symptomsof malignancy: weight loss, malaise, anorexia
what are the signs of cholangiocarcinoma on physical examination?
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
what is 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)
what are the investigations for cholangiocarcinoma and interpret the results?
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
what investigations should you consider for cholangiocarcinoma?
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