Cholangiocarcinoma

Cholangiocarcinomas

Tumors originating from the epithelium of the bile duct

Classification

Intrahepatic of Extrahepatic

Extrahepatic

Extrahepatic bile duct, from the junction of the right and left bile ducts to the common bile duct

Incidence

8000

Trend in incidence and why

Increasing; likely due to increased differentiation of intrahepatic disease

Most common in which country

Southeast Asia due to parasites

Predisposing risk factors

None

Diagnosis

• often incidental during gallbladder surgery

• Multiphasic Abd/Pelvic CT/MRI

• Chest CT

• LFTs, CA19-9, Carcinoemryonic antigen

• Established tissue diagnosis prior to surgery is dependent on situation

Histopathology

• 90% adenocarcinomas

• Extrahepatic more common

• Mass forming, periductal infiltrating, intraductal growing

Local survival rate

52%

Advanced survival rate

2%

Surgery options

• complete resection only potentially curative if possible

• Liver transplantation curative if LN-, local, nondisseminated hilar

Radiation uses

• local-regional therapy for intrahepatic

• Adjuvant w/chemo

Systemic treatments

• gemcitabine

• Capecitabine (preferred adjuvant)

• 5-FU

• Oxaliplatin

• Cisplatin