Cholangiocarcinoma

Question 1

Define cholangiocarcinoma?

Answer 1

Primary adenocarcinoma of the biliary tree

Question 2

What are risk factors of cholangiocarcinoma?

Answer 2

UC + Primary sclerosing cholangitis
Choledochal Cyst (congenital conditions involving cystic dilations of bile ducts)
Caroli disease (rare genetic condition in which you get dilation of intrahepatic bile ducts)
Parasitic infection of biliary tree

Question 3

What is the epidemiology of cholangiocarcinoma?

Answer 3

VERY RARE

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

Question 4

What are the presenting symptoms of cholangiocarcinoma?

Answer 4

Obstructive jaundice symptoms
Abdominal pain or fullness
Systemic symptoms of malignancy

Question 5

What are obstructive jaundice symptoms?

Answer 5

Yellow sclera
Pale stools
Dark urine
Pruitus

Question 6

What are systemic symptoms of malignany?

Answer 6

Weight Loss
Malaise
Anorexia

Question 7

What are the signs of cholangiocarcinoma on physical examination?

Answer 7

Jaundice
Palpable Gallbladder
Epigastric/RUQ mass
There may be hepatomegaly

Question 8

What is Courvoisier’s Law and why is it relavent?

Answer 8

In the presence of jaundice, a palpable gallbladder (that is non-tender) is unlikely to be due to gallstones
It is more likely to be cancer of the pancreas or biliary tree (cholangiocarcinoma)

Question 9

What bloods would you do for cholangiocarcinoma?

Answer 9

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

Question 10

Why do we do Endoscopy for cholangiocarcinoma?

Answer 10

ERCP will allow bile cytology and tumour Biopsy

Question 11

What investigations do we do for staging of cholangiocarcinoma?

Answer 11

CT
MRI
Bone Scan