Choliangiocarcinoma

Question 1

What is Choliangiocarcinoma?

Answer 1

An adenocarcinoma that arises anywhere in the biliary tree: intra hepatic bile ducts to common bile ducts.

Question 2

He where does a cholangiocarcinoma mostly occur?

Answer 2

1. Ports hepatis
2. Distal tumours obstruct the main ducts and present early
3. Intra hepatic tumours present late, can be mistaken for hepatocellular carcinoma

Question 3

In the majority of cases, the cause of cholangiocarcinoma is unknown. in the remainder what conditions are associated with it?

Answer 3

1. Primary sclerosing cholangitis: with ulcerative colitis
2. Congenital fibropolcystic disease
3. Biliary cirrhosis: biliary atresia
4. Chronic infection: Clonorchis sinensis Far east

Question 4

What are the clinical symptoms for cholangiocarcinoma?

Answer 4

1. Jaundice, pruritis (different to biliary cirrhosis)
2. Mild epigastric pain
3. Anorexia
4. Weight loss
5. diarrhoea

Question 5

On examination of a patient with cholangiocarcinoma what are the signs?

Answer 5

1. Hepatomegaly
2. Palpable gall bladder
3. Splenomegaly/ascites: rare

Question 6

What investigations are carried out?

Answer 6

1. Haematology: anaemia/raised leucocytes
2. Biochemistry: raised serum bilirubin, ALK, ¥GT
3. Normal alpha-feto-protein
4. Faeces: pale/fatty/blood

Question 7

What diagnostic procedures are carried out?

Answer 7

1. Ultrasound
2. ERCP: Endoscopic retrograde cholangio-pancreatography
3. CT/MRI
4. Angiography and venography

Question 8

What is the treatment for Cholangiocarcinoma?

Answer 8

1. Surgery: removal

2. Bypass: anastomosis of jejenum