Cholangiocarcinoma Flashcards
What is cholangiocarcinoma?
Primary adenocarcinoma of the biliary tree
Describe the aetiology of cholangiocarcinoma
UNKNOWN
List 9 risk factors for cholangiocarcinoma
Age > 50
UC + PSC
Choledocholithiasis + Cholecystolithiasis
Choledochal cyst (congenital conditions involving cystic dilatations of bile ducts)
Non-specific cirrhosis
Alcoholic liver disease
Caroli disease (rare genetic condition with dilatation of intrahepatic bile ducts)
HCV/ HBV/ HIV
Parasitic infection of biliary tract
Describe the epidemiology of cholangiocarcinoma
VERY RARE
More common in developing world due to higher prevalence of parasitic infections
M > F due to higher occurrence of PSC in men
List 5 symptoms of obstructive jaundice seen in cholangiocarcinoma
Yellow sclera Pale stools Dark urine Pruritus Abdominal pain or fullness
List 5 signs of cholangiocarcinoma
Jaundice
Palpable gallbladder which is NON-TENDER
Epigastric/ RUQ mass
Hepatomegaly
May have acute cholangitis triad: fever, jaundice, RUQ pain
What bloods should be taken in cholangiocarcinoma?
FBC U+Es LFTs (high ALP + GGT + BR + PTT) Clotting screen Tumour markers
What tumour markers may be seen in cholangiocarcinoma?
CEA High in IBD + cholangiocarcinoma (+ other tumours)
CA19-9: marker of pancreatic cancer + cholangiocarcinoma
CA-125: High in up to 65% of pts
Why perform an ultrasound in cholangiocarcinoma?
Distinguish between malignant + benign lesions
What investigations may be considered in cholangiocarcinoma?
Endoscopy: ERCP allows bile cytology + tumour biopsy
CT, MRI, Bone Scan: for staging
PTC: when tumour causes complete obstruction + ERCP is unable to assess the biliary tree proximal to the tumour
What is Courvoisier’s Law?
In presence of jaundice, a palpable gallbladder (non-tender) is unlikely to be due to gallstones (i.e. cancer of the pancreas or biliary tree is more likely)
List 3 systemic symptoms of malignancy seen in cholangiocarcinoma
Weight loss
Malaise
Anorexia
