GI: Cholangiocarcinoma Flashcards

1
Q

Which cancer type are cholangiocarcinomas most commonly?

A

> 90% are ductal adenocarcinomas (from aholangiocytes), the rest are squamous cell tumours

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2
Q

Where can cholangiocarcinomas occur and how are they classified according to location?

A

Can occur in any part of the biliary tree:

  1. intra-hepatic: small intra-hepatic bile ducts
  2. peri-hilar: most common, esp. near bifurcation of right and left hepatic ducts (Klastskin tumours)
  3. distal
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3
Q

Where to cholangiocarcinomas typically metastasise to?

A
  • local lymph nodes
  • peritoneal cavity
  • lung
  • liver
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4
Q

Name some of the risk factors for cholangiocarcinoma.

A

Often idiopathic but risk factors include:

  1. Biliary tract disorders
    - primary sclerosing cholangitis (secondary to UC, 10-20% lifetime risk)
    - congenital bile duct abnormalities, e.g. choledochal cysts
  2. Infective
    - liver flukes
    - chronic hepC (intrahepatic form)
    - HIV (intrahepatic form)
  3. Toxins
    - rubber and aircrafft inustry
    - thorium exposure
  4. Other
    - obesity
    - diabetes
    - alcohol excess
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5
Q

Describe the usual presentation of cholangiocarcinoma.

A

Generally asymptomatic until late stage disease.

  • post-hepatic obstruction Sx: jaundice, pruritis, pale stool and dark urine
  • RUQ pain (dull ache), esp. in advanced disease
  • weight loss, anorexia and malaise

+/- hepatomegaly, splenomegaly
+/- palpable gallbladder (tumours distal to cystic duct)

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6
Q

What blood results would be expected in a pt with cholangiocarcinoma?

A
  1. LFTs: increased bilirubin, increased GGT, increased ALP (post-hepatic jaundice features)
  2. Tumour markers: CEA an CA19-9 may be raised
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7
Q

What imaging would you request for a pt with suspected cholangiocarcinoma?

A
  1. MRCP (gold standard for diagnosis): shows site of obstruction
  2. ERCP: may be use to obtain samples for biopsy or cytological analysis
  3. USS biliary tract: hilar tumours show dilation of intrahepatic biliary tree
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8
Q

what is the treatment for a pt with cholangiocarcinoma?

A

Complete surgical resection is only chance of cure but <33% are resectable at diagnosis.

Palliative:

  • ERCP may be used to stent the bile duct to relieve symptoms. Are prone to occlusion and may need replacing every 3mths.
  • Radiotherapy may be used in some cases as adjunct or neoadjuvant or palliative therapy.
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