Diagnostic-therapeutic management of bile duct cancer (original) (raw)
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Diagnosis and treatment of biliary malignancies: biopsy, cytology, cholangioscopy and stenting
Mini-invasive Surgery, 2021
Biliary tract malignancies include cancers of the intra-hepatic and extra-hepatic bile ducts. Cholangiocarcinoma is the predominant biliary tract malignancy with nearly 60% of them occurring in the peri-hilar region. They can present with biliary strictures causing jaundice but can be insidious and present late in their clinical course. Recent advances in imaging and other diagnostic modalities help in the earlier identification of these tumors. Diagnosis should be suspected in anyone presenting with jaundice with evidence of biliary ductal dilatation or in patients with primary sclerosing cholangitis with worsening clinical status. The diagnostic approach consists of obtaining tumor markers, mainly CA 19-9, imaging modalities which include computed tomography and/or magnetic resonance imaging to establish the level of biliary obstruction and presence or absence of mass. Tissue sampling is performed with endoscopic retrograde cholangiopancreatography (ERCP) guided cytology and biopsies and with endoscopic ultrasound (EUS) if a mass is visible on imaging. Indeterminate strictures after initial biopsies could be further evaluated by cholangioscopy directed biopsies. Treatment for resectable and distal bile duct cancers involves surgical referral, but palliative biliary drainage is the key for unresectable cancers. Metal stents are generally preferred for distal cancers and plastic stents for proximal cancers. EUS guided biliary drainage can be an alternative approach in patients with failed ERCP.
Main bile duct carcinoma management. Our experience on 38 cases
Annali italiani di chirurgia
Cholangiocarcinoma (CC) is rare malignant tumors arising from cells of the biliary tract. It presents some difficulties to diagnose, and is associated with a high mortality. Traditionally extrahepatic CC is divided into klatskin tumors, intermediate tract and distal or iuxtapapillar tumors according to its location within the biliary tree. CT RM, PET may provide useful diagnostic information in those patients. Surgical resection is the only chance for cure, with results depending on selected patients and careful surgical technique. Liver transplantation could offer long-term survival in selected patients when combined with chemotherapy. Chemotherapy, radiation therapy, and external drainage remain as the only treatment for inoperable patients. The authors report their experience since 1997 inherent to 38 cases of extrahepatic CC, 21 of which were treated by surgery: their outcome has been evaluated. Surprisingly four of them (2 with intermediate tract tumor and 2 with distal tract t...
Bile Duct Cancer: Preoperative Evaluation and Management
Bile Duct Cancer [Working Title]
Cholangiocarcinomas (CCAs) are malignant tumors that can develop anywhere along the biliary tree. Almost 10% of cholangiocarcinomas arise from the intrahepatic bile ducts (iCCA); 50-60% from the bifurcation of the hepatic duct (perhilar cholangiocarcinoma, pCCA); and 20-30% from the distal bile duct (dCCA). The 7th edition of the AJCC staging system, released in 2010, divides the tumors into two major categories: perihilar (pCCA) and distal (dCCA) cholangiocarcinoma, given the differences in anatomy of the bile duct and consideration of local factors related to resectability. There are separate histological classifications for intrahepatic and extrahepatic cholangiocarcinoma. The majority of CCAs (90%) are well or moderately differentiated adenocarcinomas. Other features include invasiveness with early neural, perineural, periductal and lymphatic infiltration (more than 50% of cases at diagnosis) and longitudinal subepithelial infiltration along the wall of the bile duct up to 2 cm proximally and 1 cm distally. In this chapter the extrhepatic bile duct cancers are analyzed.
Clinical diagnosis and staging of cholangiocarcinoma
Nature reviews. Gastroenterology & hepatology, 2011
Cholangiocarcinoma is the most frequent biliary malignancy. It is difficult to diagnose owing to its anatomic location, growth patterns and lack of definite diagnostic criteria. Currently, cholangiocarcinoma is classified into the following types according to its anatomic location along the biliary tree: intrahepatic, perihilar or distal extrahepatic cholangiocarcinoma. These cholangiocarcinoma types differ in their biological behavior and management. The appropriate stratification of patients with regard to the anatomic location and stage of cholangiocarcinoma is a key determinate in their management. Staging systems can guide this stratification and provide prognostic information. In addition, staging systems are essential in order to compare and contrast the outcomes of different therapeutic approaches. A number of staging systems exist for cholangiocarcinoma-several early ones have been updated, and new ones are being developed. We discuss the emerging diagnostic criteria as wel...
World journal of gastrointestinal endoscopy, 2015
In the last decades many advances have been achieved in endoscopy, in the diagnosis and therapy of cholangiocarcinoma, however blood test, magnetic resonance imaging, computed tomography scan may fail to detect neoplastic disease at early stage, thus the diagnosis of cholangiocarcinoma is achieved usually at unresectable stage. In the last decades the role of endoscopy has moved from a diagnostic role to an invaluable therapeutic tool for patients affected by malignant bile duct obstruction. One of the major issues for cholangiocarcinoma is bile ducts occlusion, leading to jaundice, cholangitis and hepatic failure. Currently, endoscopy has a key role in the work up of cholangiocarcinoma, both in patients amenable to surgical intervention as well as in those unfit for surgery or not amenable to immediate surgical curative resection owing to locally advanced or advanced disease, with palliative intention. Endoscopy allows successful biliary drainage and stenting in more than 90% of pa...
Surgical management of biliary malignancy
Current Problems in Surgery, 2020
Cholangiocarcinoma is a malignancy arising from the epithelial lining of the biliary ducts. The disease is further subdivided by anatomic location, namely intrahepatic, perihilar, and extrahepatic. Intrahepatic cholangiocarcinoma (IHCC) has also been referred to as cholangiocellular carcinoma, cholangiolar carcinoma, and peripheral cholangiocarcinoma. In 1990, IHCC was formally defined as malignancy arising from the biliary epithelium proximal to the left and right main ducts, 1 and subsequent studies have verified the utility of this classification for prognosis and management. 2,3 Because IHCC arises in the peripheral biliary tree within the parenchyma of the liver, it is associated with unique diagnostic and therapeutic challenges. Epidemiology-IHCC accounts for 10% to 15% of all primary liver cancers and is the second most common primary liver malignancy after hepatocellular carcinoma. Despite this, it is a rare cancer and accounts for less than 1% of all gastrointestinal(GI) malignancies. The annual incidence of IHCC varies widely across the globe, ranging from 85/100,000 in Northeastern Thailand to 0.3/100,000 in Israel. 4 In the US, the overall age-adjusted incidence is 1.31/100,000 per year. 5
“Diagnostic-Therapeutic Management in Patients with Extrahepatic Bile Duct Cancer”
International Journal of Medical Science and Clinical Invention, 2021
Introduction: Biliary tract tumors, or cholangiocarcinomas (CCAs), comprise a heterogeneous group of malignant tumors that can affect any part of the biliary tree, from the interlobular canals of Hering to the primary biliary duct. In the last 20-30 years, the incidence of these tumours has increased especially after the introduction of the new imaging techniques endoscopic retrograde cholangiopancreatography (ERCP, percutaneous transhepatic cholangiography) and the increased interest for this pathology. Objective: To evaluate the diagnostic methods and therapeutical results in patients with extrahepatic bile duct cancer. Material and Method: This cross-sectional study was conducted in the Department of Surgery, Department of Surgery, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from Jun-2018 to July-2021. We included 124 consecutive patients with suspected bile duct cancer who underwent endoscopic retrograde cholangiopancreatography (ERCP). Every patient underwent an...
Digestive disease interventions, 2017
Cholangiocarcinoma (CC) originates from epithelial cells of the biliary tree. They account for approximately 10 to 15% of all hepatobiliary malignancies, second only to hepatocellular carcinoma (HCC). 1 The incidence rates of CC vary among different geographic locales, according to diverse risk factors in different parts of the world. 2 The development of CC is associated with conditions that result in hepatobiliary inflammation and cholestasis, including primary sclerosing cholangitis, choledochal cysts, hepatolithiasis, and parasitic infections. 2-5 The vast majority (95%) of CCs are adenocarcinomas, but less common histologic types have also been reported. 6 Men tend to be affected 1.5 times more commonly than women. 2 CCs are classified into two anatomically distinct subtypes: intrahepatic CC (ICC) and extrahepatic CC (ECC). 7 ICCs are further characterized as either perihilar or peripheral. 8 Recent studies have suggested further subtyping of ICC into two distinct histological types, based on mucin production and immunophenotypes. 9 As the name implies, perihilar CC develops at the level of bifurcation of the left and right hepatic ducts, whereas peripheral CC arises more distally, usually from more peripherally located ducts. 10,11 Growth patterns have been described as mass forming (most common), periductal, intraductal, or mixed. 12-14 Various staging systems have been developed in an attempt to either describe disease extent and/or surgical candidates. The Bismuth-Corlette's classification focuses on the extent of tumor invasion into the biliary tree. 15 The American Joint Committee on Cancer/International Union Against Cancer system is based on the pathological TNM staging. 13 The Memorial Sloan Kettering system attempts to classify tumors based on factors related to local extension of tumor, location of bile duct involvement, and presence of portal vein invasion. 14 The overall prognosis of CC is poor, and surgery offers the only potential for cure. Surgical resection with microscopically negative margins is the objective for cure and offers the best long-term survival. 16-19 Unfortunately, up to 20 to 50% of patients are deemed unresectable at presentation due to advanced disease. Factors that preclude surgical resection include bilateral ductal involvement to the level of the second order bile ducts, tumor involvement of the proper hepatic artery, bilateral hepatic arteries, main portal vein, metastatic lymphadenopathy, or peritoneal carcinomatosis. 20,21 Nonsurgical treatment options differ depending on the location, stage, and extent of disease. Because many patients present clinically with advanced disease, treatment goals are often directed toward mitigating the consequences of biliary obstruction. Relief of biliary obstruction can be achieved by biliary drainage Keywords ► cholangiocarcinoma ► magnetic resonance imaging ► cholangiography ► computed tomography
Classification, Diagnosis, and Management of Cholangiocarcinoma
Clinical Gastroenterology and Hepatology, 2013
Cholangiocarcinomas (CCAs) are tumors that develop along the biliary tract. Depending on their site of origin, they have different features and require specific treatments. Classification of CCAs into intrahepatic, perihilar, and distal subgroups has helped standardize the registration, treatment, and study of this lethal malignancy. Physicians should remain aware that cirrhosis and viral hepatitis B and C are predisposing conditions for intrahepatic CCA. Treatment options under development include locoregional therapies and a chemotherapy regimen of gemcitabine and cisplatin. It is a challenge to diagnose perihilar CCA, but an advanced cytologic technique of fluorescence in situ hybridization for polysomy can aid in diagnosis. It is important to increase our understanding of the use of biliary stents and liver transplantation in the management of perihilar CCA, as well as to distinguish distal CCAs from pancreatic cancer, because of different outcomes from surgery. We review advances in the classification, diagnosis, and staging of CCA, along with treatment options.
Cholangioscopic findings in bile duct tumors
Gastrointestinal Endoscopy, 2000
Background: Cholangioscopy has been used in the treatment of bile duct stones and the diagnosis of various bile duct tumors. However, the cholangioscopic characteristics of the various types of bile duct tumors have not been clearly described. We analyzed the results of cholangioscopic examinations and classified the findings according to tumor histology. Methods: Cholangioscopic findings from 111 patients with benign or malignant bile duct tumors were reviewed. The mucosal changes, the presence of neovascularization, and the patterns of luminal narrowing were analyzed and compared with the histologic diagnosis. Results: Bile duct adenocarcinoma can be classified into 3 different types according to the cholangioscopic findings: nodular, papillary, and infiltrative. Bile duct adenoma, hepatocellular carcinoma and other types of bile duct cancer such as mucin-hypersecreting cholangiocarcinoma, biliary cystadenocarcinoma, and squamous cell carcinoma also presented unique cholangioscopic characteristics. Conclusions: Bile duct tumors exhibit characteristic cholangioscopic findings and cholangioscopy seems to be useful for differential diagnosis. (Gastrointest Endosc 2000;52:630-4.)