Cholangiocarcinoma

Question 1

Define

Answer 1

DEFINITION: primary adenocarcinoma of the biliary tree

Question 2

Causes

Answer 2

UNKNOWN

Question 3

Risk factors

Answer 3

Ulcerative colitis + primary sclerosing cholangitis

Choledochal cyst (congenital conditions involving cystic dilatations of bile ducts)

Caroli disease (rare genetic condition in which you get dilatation of intrahepatic bile ducts)

Parasitic infection of biliary tract

Question 4

Epidemiology

Answer 4

VERY RARE

More common in the developing world due to the increased prevalence of parasitic infections

Question 5

Symptoms

Answer 5

Obstructive jaundice symptoms

• Yellow sclera
• Pale stools
• Dark urine
• Pruritus

Abdominal pain or fullness

Systemic symptoms of malignancy: weight loss, malaise, anorexia

Question 6

Signs

Answer 6

Jaundice

Palpable gallbladder

• NOTE: Courvoisier’s Law - in the presence of jaundice, a palpable gallbladder (that is non-tender) is unlikely to be due to gallstones (i.e. cancer of the pancreas or biliary tree is more likely)

Epigastric/RUQ mass

There may be hepatomegaly

Question 7

Investigations

Answer 7

Bloods

• FBC
• U&Es
• LFTs (high ALP + GGT)
• Clotting screen
• Tumour markers
  
  • CA19-9 is a marker of pancreatic cancer and cholangiocarcinoma

Endoscopy

• ERCP will allow bile cytology and tumour biopsy

Ultrasound

CT, MRI, Bone Scan - for staging