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FRCR CO2A Clinical Oncology > GALL BLADDER AND BILIARY TREE CANCERS FRCR CO2A > Flashcards

GALL BLADDER AND BILIARY TREE CANCERS FRCR CO2A Flashcards

(57 cards)

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1
Q

MOST COMMON TYPE

A

ADENOCARCINOMA 80 %

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2
Q

MALE: FEMALE RATIO

A

2:3 (GB)
1: 1 (CHOLANGIOCARCINOMA)

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3
Q

DISTRIBUTION OF CANCERS

A

GB 40%
CHOLANGIOCARCINOMA 43 % (INTRA AND EXTRAHEPATIC)
PERIAMPULLARY 13 %
OTHERS 4 %

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4
Q

RFs for Ca GB

A

obesity

gallstones, > 3 cm

polyps

chronic typhoid and paratyphoid carriers

ulcerative colitis

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5
Q

RFs for cholangiocarcinoma

A

primary sclerosing cholangitis (10 %)
clonorchis sinensis

Polycystic liver disease, gall stones
caroli’s disease

chemicals like aflatoxins, vinyl chloride, methylene chloride

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6
Q

what is caroli’s disease

A

rare congenital disease of multiple saccular dilations of the intrahepatic bile ducts

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7
Q

commonest presentation

A

obstructive jaundice (GB, bile duct):

Fluctuating jaundice (periampullary carcinoma)

wt loss, anorexia, fatiguability

Hepatomegaly, RUQ pain

palpable non tender GB

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8
Q

Bismuth classification for perihilar tumors

A

type I : below confluence of rt and lt ducts

type II: confined to confluence

type III: extension into right or left heaptic ducts

type IV: extension into right and left hepatic ducts or multcentric

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9
Q

imaging for biliary tree cancers

A
  1. USG (IHBD)
  2. CT scan (regiona LNS) and metastasis
  3. ERCP and PTBD
  4. EUS
  5. Laparoscopoy rules out peritoneal mets before curative surgery
  6. MRI , MRCP
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10
Q

curative Rx

A

Surgery but only 20 % pts have resectable tumor at presentation

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11
Q

Sx for Ca Gb

A

radical cholecystectomy

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12
Q

radical cholecystectomy includes removal of:

A

nodal dissection and excision of adjacent liver tissue

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13
Q

surgical options for bile tree cancers

A

Bile Duct
1. Bismuth I and II: en bloc resection of the bile duct, gb, LNs, Roux-enxY hepatico-jejunostomy

  1. Bismuth III: as above and right or left hemi hepatectomy
  2. Bismuth IV: as above and exxtended right or left hemi hepatectomy
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14
Q

lower third bile duct cance surgeries

A

Pancreatico-duodenectomy

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15
Q

intrahepatic cholangiocarcinoma Surgery

A

resectio of involved segments/lobes

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16
Q

Adjuvant chemo for Ca Gb T1aN0 NCCN 2025

A

observation

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17
Q

Adjuvant chemo for Ca Gb >T1aN0 NCCN 2025

A

Capecitabine
Gem Capecitabine
Gem Cisplatin

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18
Q

M1 Ca Gb or un-resectable, systemic therapies
NCCN 2025

A

Durvalumab + gemcitabine + cisplatin
(category 1)

  • Pembrolizumab + gemcitabine + cisplatin
    (category 1)

others
Gemcitabine + cisplatin (category 1)
* Capecitabine + oxaliplatin
* FOLFOX
* Gemcitabine + albumin-bound paclitaxel
* Gemcitabine + capecitabine
* Gemcitabine + oxaliplatin
* Single agents:
5-fluorouracil
Capecitabine
Gemcitabine

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19
Q

molecular therapy for metastatic disease

A

as per mutation

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20
Q

MSI-H/dMMR tumors:

A

Pembrolizumab

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21
Q

NTRK gene fusion-positive tumors

A

Entrectinib13,14
Larotrectinib15
Repotrectinib

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22
Q

TMB-H tumors:

A

Nivolumab + ipilimumabg,h,o,21
Pembrolizumabg,h,l,1

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23
Q

BRAF V600E-mutated tumors

Study These Flashcards
A

Dabrafenib + trametinib

24
Q

CCA with FGFR2 fusions or rearrangements

Study These Flashcards
A

Futibatinib28
Pemigatinib29
Erdafitinib

25
CCA with IDH1 mutations
Ivosidenib (category 1)3
26
* For HER2-positive tumors: 
Fam-trastuzumab deruxtecan-nxki (IHC3+) Trastuzumab + pertuzumab (IHC3+/ISH+/NGS amplification) Tucatinib + trastuzumab (IHC3+/ISH+/NGS amplification)35 Zanidatamab
27
RET gene fusion-positive tumors:
Selpercatinib Pralsetinib (category 2B)
28
* For KRAS G12C mutation-positive tumors:
Adagrasib
29
1 yr and 5 yr survival in biliary tract cancers
22 % and 5 to 10 %
30
factors a/w poor prognosis in biliary tract cancers?
1. LN mets 2. PNI 3. Margin + 4. perihilar tumors
31
What is carcinoma of the gallbladder?
The most common malignant lesion of the biliary tract, more common in females with a 4:1 female:male ratio. ## Footnote Gallstones are a significant risk factor, but most patients with gallstones do not develop cancer.
32
What percentage of gallbladder cancer patients have associated gallstones?
65–90%. ## Footnote Gallstones are considered an important risk factor for gallbladder cancer.
33
What are other reported risk factors for gallbladder cancer?
* Porcelain gallbladder * Gallbladder polyps of >10 mm diameter * Anomalous pancreaticobiliary duct junction (APBDI)
34
What type of cancer is most commonly associated with gallbladder cancer?
90% of tumours are adenocarcinoma; the remainder are squamous cell carcinoma.
35
How does gallbladder cancer typically spread?
By local invasion, through lymphatics, and venous blood to the liver.
36
What is the usual clinical presentation of gallbladder cancer?
An incidental finding at cholecystectomy, with features of gallstone disease and unremitting jaundice in some patients.
37
What is the initial assessment method for gallbladder cancer?
Ultrasound, which may show a complex mass filling the lumen with localized thickening of the gallbladder wall.
38
What imaging technique is useful for local staging of gallbladder cancer?
CT scan, which can establish infiltration into adjacent tissues and vessels as well as nodal or distant metastases.
39
What is the role of MRI in gallbladder cancer diagnosis?
Useful in identifying invasion of the hepatoduodenal ligament and portal vein encasement, suggestive of an unresectable tumour.
40
What surgical options are available for resectable gallbladder cancer?
* Simple cholecystectomy * Radical cholecystectomy * Radical cholecystectomy with liver resection * Radical cholecystectomy with extensive node dissection * Radical cholecystectomy with resection of the bile duct or pancreaticoduodenectomy
41
What is the prognosis for gallbladder cancer?
5-year survival is <5%; stage at diagnosis is the most important determinant of prognosis.
42
What is cholangiocarcinoma (CCA)?
Tumours arising from intrahepatic, perihilar and distal extrahepatic bile ducts, accounting for 3% of all gastrointestinal cancers.
43
What are some risk factors for cholangiocarcinoma?
* Primary sclerosing cholangitis (PSC) * Liver fluke infestation * Chronic typhoid carriers * Chronic intraductal gallstones * Choledochal cysts * Smoking in patients with PSC
44
What type of tumors comprise the majority of cholangiocarcinomas?
90% are adenocarcinoma.
45
What are common clinical features of cholangiocarcinoma?
Jaundice (>90%), pruritus, weight loss, and abdominal pain.
46
What imaging tests are used for diagnosing cholangiocarcinoma?
* Ultrasound (USS) * CT scan * MR cholangiography (MRCP) * Endoscopic retrograde cholangiopancreatography (ERCP)
47
What is the role of tissue diagnosis in cholangiocarcinoma?
Needed for unresectable or metastatic disease; can be obtained through biliary cytology, endoscopic ultrasound, or CT guided biopsy.
48
What is the aim of surgery for resectable cholangiocarcinoma?
R0 resection, which involves resection of the tumour with regional nodes and extended liver resection.
49
What is the prognosis for cholangiocarcinoma?
Poor 5-year survival of <5%; majority of patients die within 1 year.
50
What is the role of palliative chemotherapy in cholangiocarcinoma?
Gemcitabine alone or in combination with platinum agents or capecitabine may be considered for fit patients.
51
What are the reported response rates for palliative chemotherapy in cholangiocarcinoma?
15–40% with a median survival of 4–16 months.
52
Type 1 – proximal to the bifurcation Type 2 – involving hepatic duct confluence but not hepatic duct Type 3 – extending to the right (type 3A) or left (type 3B) hepatic ducts Type 4 – extends into both the right and left hepatic ducts or with multi-focal duct involvement
53
What is the treatment for Types I and II cholangiocarcinoma?
En bloc resection of the extrahepatic bile ducts and gall bladder, regional lymphadenectomy, and Roux-en-Y hepaticojejunostomy ## Footnote This surgical approach aims to remove the affected structures and restore bile flow.
54
What additional procedure is included in the treatment for Type III cholangiocarcinoma?
Right or left hepatectomy ## Footnote This involves the surgical removal of a portion of the liver along with other structures.
55
What is the treatment for Type IV cholangiocarcinoma?
Extended right or left hepatectomy along with previous procedures ## Footnote This indicates a more extensive liver resection compared to Type III.
56
How are distal cholangiocarcinomas managed?
Pancreatoduodenectomy as with ampullary or pancreatic head cancers ## Footnote This procedure is also known as the Whipple procedure.
57
How is the intrahepatic variant of cholangiocarcinoma treated?
Resection of the involved segments or lobe ## Footnote This treatment focuses on removing the specific parts of the liver affected by the cancer.

FRCR CO2A Clinical Oncology (35 decks)

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