GI: Cholangiocarcinoma Flashcards
Which cancer type are cholangiocarcinomas most commonly?
> 90% are ductal adenocarcinomas (from aholangiocytes), the rest are squamous cell tumours
Where can cholangiocarcinomas occur and how are they classified according to location?
Can occur in any part of the biliary tree:
- intra-hepatic: small intra-hepatic bile ducts
- peri-hilar: most common, esp. near bifurcation of right and left hepatic ducts (Klastskin tumours)
- distal
Where to cholangiocarcinomas typically metastasise to?
- local lymph nodes
- peritoneal cavity
- lung
- liver
Name some of the risk factors for cholangiocarcinoma.
Often idiopathic but risk factors include:
- Biliary tract disorders
- primary sclerosing cholangitis (secondary to UC, 10-20% lifetime risk)
- congenital bile duct abnormalities, e.g. choledochal cysts - Infective
- liver flukes
- chronic hepC (intrahepatic form)
- HIV (intrahepatic form) - Toxins
- rubber and aircrafft inustry
- thorium exposure - Other
- obesity
- diabetes
- alcohol excess
Describe the usual presentation of cholangiocarcinoma.
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)
What blood results would be expected in a pt with cholangiocarcinoma?
- LFTs: increased bilirubin, increased GGT, increased ALP (post-hepatic jaundice features)
- Tumour markers: CEA an CA19-9 may be raised
What imaging would you request for a pt with suspected cholangiocarcinoma?
- MRCP (gold standard for diagnosis): shows site of obstruction
- ERCP: may be use to obtain samples for biopsy or cytological analysis
- USS biliary tract: hilar tumours show dilation of intrahepatic biliary tree
what is the treatment for a pt with cholangiocarcinoma?
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.