Cholangiocaricinoma

Question 1

what is it?

Answer 1

Mostly adenocarcinomas.

Tumour that affects the bile ducts - intra or extra hepatic ducts.

Question 2

most common site?

Answer 2

where the left and right ducts join together just after they leave the liver

Question 3

key risk factors?

Answer 3

liver flukes (parasitic infection)
primary sclerosis cholangitis
Patients with UC - at risk of PSC
Patients with PSC - at risk of colangiocarcinoma.

Question 4

presentation?

Answer 4

Obstructive jaundice 
pale stools
dark urine
generalised itching 
RUQ pain
palpable gallbladder 
hepatomegaly 

Coirviosiers law - Palpable gallbladder + jaundice will be cholangiocarcinoma or pancreatic cancer, very unlikely to be gallstones.

Question 5

painless jaundice?

Answer 5

Cholangiocarcinoma or pancreatic cancer

Pancreatic cancer is more common

Question 6

tumour marker?

Answer 6

Ca 19-9.

Raised in cholangiocarcinoma and pancreatic cancer.

Question 7

ERCP?

Answer 7

used to put a stent in to relieve obstruction and get a biopsy

Question 8

treatment?

Answer 8

Curative in early stages -

Mostly palliative treatment - stents, bypassing biliary obstruticiton, chemo, radio.