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GI > Neoplasia of Biliary Tract & GB > Flashcards

Neoplasia of Biliary Tract & GB Flashcards

1
Q

What is cholangiocarcinoma?

A

bile duct malignancy

subtypes-Bismuth corlette classifcation

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2
Q

What is happening to hte rates of intrahepatic and extrahepatic cholangiocarcinoma?

A

intrahepatic increasing

extrahepatic decreasing

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3
Q

Who gets cholangiocarcinoma?

A

men, 50-70 yo

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4
Q

What is the most important risk factor for CCA?

A

PSC

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5
Q

What is the precursor lesion for CCA?

A

Biliary intraepithelial neoplasia (BiIIN)

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6
Q

What type of cancer is CCA usually?

A

adenocarcinoma-sclerosing type

also nodular-highly invasive, and papillary-most curable

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7
Q

How does extrahepatic CCA present?

A

symptomatic from biliary obstruction
jaundice, abd pain, pruritus, wt loss, fever
Courvoisier’s sign
cholestatic liver test elevation

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8
Q

What is courvoisier’s sign?

A

palpable gallbladder due to biliary obstruction distal to the cystic duct

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9
Q

How does intrahepatic CCa present?

A

abd pain, wt loss

cholestatic liver test elevation

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10
Q

How is CCA dx?

A

blood work (limited value due to false positives and negatives of CA 19-9 & CEA)
ultrasound with duplex
CT, MRI, PET, angiography, ERCP, PTC
endoscopic ultrasound

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11
Q

CCA tx?

A 
curative surgery
-distal:whipple
-perihilar: bile duct resection
adjuvant chemo/chemrad
neoadjuvant chemrad
liver transplant (intra and perihilar)
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12
Q

What is done for palliative CCA therapy?

A

surg bypass, biliary stenting, photodynamic therapy, intraarterial chemo

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13
Q

CCA prognosis?

A

5-10% 5yr survival

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14
Q

Epidemiology of GB cancer?

A

uncommon

women

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15
Q

Risk factors for GB cancer?

A

porcelain GB, GB polyps, APBJ, cholelithiasis

salmonella typhi, obesity, carcinogens

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16
Q

How does GB cancer happen?

A 
1. gallstones and chronic irritation of the mucosa
early-p53 mutation
late-K-ras (rare)
2. APBJ
early-K-ras
late-p53 (rare)
17
Q

What subtype of GB cancer is most common?

A

adenocarcinoma

18
Q

What are the 4 typical presentation of GB cancer?

A
  1. incidental on imaging
  2. found intraoperatively during cholecystectomy for presumed benign disease
  3. found incdientally on pathologic examination
  4. symptomatically-pain, anorexia, nausea, vomiting, jaundice from biliary obstruction
19
Q

How can you diagnose GB cancer?

A

NOT with labs
abd us
EUS
CT, MRI

20
Q

Tx for GB cancer?

A

surgery
adjuvant rad or chemo
palliative rad or chemo

21
Q

GB cancer prognossi?

A

generally poor, advanced at dx usually, many structures nearby for spread

GI (20 decks)

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