Cholangiocarcinoma

Question 1

What is the term for cancers arising from the biliary tree epithelium and what type of cancer is it?

Answer 1

Cholangiocarcinoma - 95% adenocarcinoma

Question 2

What is this a presentation of?

>55 years old, painless jaundice, weight loss and abdominal pain.

Answer 2

Cholangiocarcinoma

Question 3

What are the risk factors for cholangiocarcinoma?

Answer 3

Any biliary pathology (primary sclerosing cholangitis), liver disease, HBV, HCV, HIV.

Question 4

How is cholangiocarcinoma investigated?

Answer 4

1. Abdominal USS
2. High conjugated bilirubin, ALP, GGT, ALT/AST
3. High CA19-9

Question 5

What is the difference in Treatment between cholangiocarcinoma and choledocholithiasis?

Answer 5

ERCP will treat choledocholithiasis and not cholangiocarcinoma.

Question 6

What are the important differentials that histology will differentiate between for cholangiocarcinoma?

Answer 6

Pancreatic and ampullary carcinoma

Question 7

What is the treatment of cholangiocarcinoma and what is the prognosis?

Answer 7

1. 70% inoperable at presentation
2. Surgery involves major hepatectomy and extrahepatic bile duct resection.
3. Very poor prognosis (5 months)