Cholangiocarcinoma

Question 1

Define cholangiocarcinoma

Answer 1

Primary adenocarcinoma of the biliary tree

Question 2

Aetiology of cholangiocarcinomas

Answer 2

Unknown

Question 3

Risk factors for cholangiocarcinomas

4

Answer 3

Ulcerative colitis & primary sclerosing cholangitis
Choledochal cysts
Caroli disease
Parasitic infection of biliary tract

Question 4

Epidemiology of cholangiocarcinomas

prevalence, location

Answer 4

VERY RARE

More common in developing world

Question 5

Presenting symptoms of cholangiocarcinomas

3, 1, 3

Answer 5

Obstructive jaundice symptoms
Yellow sclera
Pale stools
Dark urine
Pruritus 

Abdominal pain or fullness

Systemic symptoms of malignancy
Weight loss
Malaise
Anorexia

Question 6

Signs of cholangiocarcinoma on physical examination

4

Answer 6

Jaundice
Palpable gallbladder
Epigastric/RUQ mass
May be hepatomegaly

Question 7

Investigations for cholangiocarcinoma

6

Answer 7

Bloods
Endoscopy
US
CT, MRI, bone scan - to stage

Question 8

Investigations for cholangiocarcinoma - bloods

5

Answer 8

FBC
U&Es
LFTs - high ALP & GGT
Clotting screen
Tumour markers - CA19-9

Question 9

Investigations for cholangiocarcinoma - endoscopy

1

Answer 9

ERCP will allow bile cytology & tumour biopsy