Chapter 53: Biliary Tract- Cholangiocarcinoma

Question 1

What is it?

Answer 1

Malignancy of the extrahepatic or intrahepatic ducts—primary bile duct cancer

Question 2

What is the histology?

Answer 2

Almost all are adenocarcinomas

Question 3

Average age at diagnosis?

Answer 3

≈65 years, equally affects male/female

Question 4

What are the signs and symptoms?

Answer 4

Those of biliary obstruction: jaundice, pruritus, dark urine, clay-colored stools,cholangitis

Question 5

What is the most common location?

Answer 5

Proximal bile duct

Question 6

What are the risk factors?

Answer 6

• Choledochal cysts
• Ulcerative colitis
• Thorotrast contrast dye (used in 1950s)
• Sclerosing cholangitis
• Liver flukes (clonorchiasis)
• Toxin exposures (e.g., Agent Orange)

Question 7

What is a Klatskin tumor?

Answer 7

Tumor that involves the junction of the right and left hepatic ducts

Question 8

What are the diagnostic tests of choice?

Answer 8

Ultrasound, CT scan, ERCP/PTC with biopsy/brushings for cytology, MRCP

Question 9

What is an MRCP?

Answer 9

MRI with visualization of pancreatic and bile ducts

Question 10

What is the management of proximal bile duct cholangiocarcinoma?

Answer 10

Resection with Roux-en-Y hepaticojejunostomy (anastomose bile ducts to jejunum) ± unilateral hepatic lobectomy

Question 11

What is the management of distal common bile duct cholangiocarcinoma?

Answer 11

Whipple procedure