cholangiocarcinoma Flashcards
(22 cards)
What are the four common types of primary malignant liver tumors?
- Hepatocellular carcinoma (hepatoma) 2. Cholangiocarcinoma (when
intrahepatic) - Angiosarcoma (associated with chemical
exposure) - Hepatoblastoma (most common in
infants and children)
What is cholangiocarcinoma?
Primary adenocarcinoma of bile ducts (95% adenocarcinoma)
Klatskin’s tumor
Cholangiocarcinoma of bile duct at the junction of the right and left hepatic ducts
What is the differential diagnosis of proximal bile duct obstruction?
Cholangiocarcinoma Lymphadenopathy Metastatic tumor Gallbladder carcinoma Sclerosing cholangitis Gallstones
Tumor embolus Parasites Postsurgical stricture Hepatoma
Benign bile duct tumor
what is SCLEROSING CHOLANGITIS
Multiple inflammatory fibrous thickenings of bile duct walls resulting in biliary strictures. Progressive obstruction possibly leading to cirrhosis and liver failure; 10% of patients will develop cholangiocarcinoma
Average age at diagnosis? (cholangiocarcinoma)
65 years, equally affects male/female
What are the signs and symptoms? (cholangiocarcinoma)
Those of biliary obstruction: painless jaundice,
pruritus, dark urine, clay-colored stools, cholangitis (10-30%), mild right upper quadrant pain, anorexia, malaise, and weight loss. elevations of alk phos and gamma glutamyl transferase
What is the most common location? (cholangiocarcinoma)
proximal bile duct
What are the risk factors? (cholangiocarcinoma)
Choledochal cysts Ulcerative colitis Thorotrast contrast dye (used in 1950s) Sclerosing cholangitis Liver flukes (clonorchiasis) Toxin exposures (e.g., Agent Orange)
What are the diagnostic tests of choice? (cholangiocarcinoma)
Ultrasound, CT scan, ERCP/PTC with
biopsy/brushings for cytology, MRCP
What is the management of proximal bile duct cholangiocarcinoma?
Resection with Roux-en-Y hepaticoje-junostomy (anastomose bile ducts to jejunum) - unilateral hepatic lobectomy
What is the management of distal common bile duct cholangiocarcinoma?
Whipple procedure
what is the morphology? (cholangiocarcinoma)
nodular, most common,
scirrhous,
diffusely infiltrating, or
papillary
what are the histologic subtypes? (cholangiocarcinoma)
acinar, ductular, trabecular, alveolar, and papillary (better outcome)
how are these tumors classified? (cholangiocarcinoma)
by location (upper half / lower half)
The standard workup if a liver biopsy comes back adenocarcinoma?
CEA, AFP, upper and lower endoscopy; CT, and, in women, a mammogram
what do you assess on imaging? (cholangiocarcinoma)
dilated intrahepatic biliary ducts with a normal, collapsed gallbladder, and, depending on the level of the tumor, a nondilated or partially dilated extrahepatic biliary tree. hilar adenopathy. Portal vein patency. hepatic lobar atrophy.
what imaging studies can you order? (cholangiocarcinoma)
US, CT, helical CT, MRCP
T staging: (cholangiocarcinoma)
TX
Primary tumor cannot be assessed
T0
No evidence of primary tumor
Tis
Carcinoma in situ
T1
Tumor confined to bile duct histologically
T2
Tumor invades beyond the wall of the bile duct
T3
Tumor invades the liver, gallbladder, pancreas, or unilateral branches of the portal vein or hepatic artery
T4
Tumor invades any of the following: main portal vein or its branches, common hepatic artery, or other adjacent structures (e.g., colon, stomach, duodenum, abdominal wall).
mortality for upper-half lesion resection (cholangiocarcinoma)
<10%
prognosis after esection for hilar lesion resection (cholangiocarcinoma)
the median survival is 35 months with a 5-
year survival rate of 10% to 30%
treatment of unresectable hilar lesion? (cholangiocarcinoma)
Palliative bypass
