cholangiocarcinoma

Question 1

define cholangiocarcinoma?

Answer 1

● Primary adenocarcinoma of the biliary tree

Question 2

main risk factors of cholangiocarcinoma?

Answer 2

o Primary sclerosing cholangitis

o Ulcerative cholangitis

Question 3

epidemiology of cholangiocarcinoma?

Answer 3

it is very rare

Question 4

presenting symptoms of cholangiocarcinoma?

Answer 4

●	Persistent biliary colic 
●	Obstructive jaundice symptoms
o	Yellow sclera
o	Pale stools 
o	Dark urine 
o	Pruritus
●	Systemic symptoms of malignancy

Question 5

signs of cholangiocarcinoma on examination?

Answer 5

● Jaundice
● Palpable gallbladder (Courvoisier’s sign)
● Periumbilical lymphadenopathy
● hepatomegaly

Question 6

what is Courvoisier’s Law ?

Answer 6

in the presence of jaundice, a palpable gallbladder (non tender) is unlikely to be due to gallstones
- more likely to be due to pancreatic cancer or cholangiocarcinoma

Question 7

bloods for cholangiocarcinoma?

Answer 7

● Bloods
o LFTs (high ALP + GGT)
o Tumour markers
● CA19-9 is a marker of pancreatic cancer and cholangiocarcinoma

Question 8

what other investigations might be necessary?

Answer 8

● Endoscopy
o ERCP will allow bile cytology and tumour biopsy
● Ultrasound
● CT, MRI, Bone Scan - for staging