Cholangiocarcinoma

Question 1

Define Cholangiocarcinoma

Answer 1

Cholangiocarcinoma are cancers arrising from bile duct epithelium

either intrahepatic or extra hepatic (perihilar or distal)
perihilar are called klatskins tumour-95% are adenocarcinomas

Question 2

Aetiology and risk factors of Cholangiocarcinoma

Answer 2

Little is known about molecular biology and development of billiary cancer
Aetiology tends to be inflammatory/infection/genetic
associated with liver cirrhosis, alcoholic liver disease and more
also HIV

risk factors: Liver inflammatory disease (Cirrosis, alcoholic liver disease,
HIV, UC, disorders of Biliary architecture
Primary sclerosing cholangitis
Typhoid, liver flukes, drinking, drugs
Age (over 50)

Question 3

Epidiemology of Cholangiocarcinoma

Answer 3

between 50-70, mild male predominance
Lowest in canada (0.3 per 100000)
Medium in europe
highest in Thailand, South America, highest in New Mexico

slightly on the rise

Question 4

signs and Sx of Cholangiocarcinoma

Answer 4

Risk factors-
90%-PAINLESS jaudice
Weight loss (FLAWS)
35% -abdopain
Pruritus

Cholangitis signs (RUQ, Fever, jaundice)

if OBSTRUCTIVE-stratthorhea and dark urine

Question 5

Investigations of Cholangiocarcinoma

Answer 5

if obstructive - high CONJUGATED bilirubin
High AlkPhos,
high GGT
ALT not as raised (except if liver metastasis
APTT/PT high-not absorbing fat soluble vitamins

Serum CA-19-85% have it raised (can also be pancreatic or gastric cancer)

Abdo USS and ABdo CT

Stage with MR angiography

ERCP-can see where it constrict-