Disease is often well established at diagnosis limiting treatment options
- Cholangiocarcinoma is a malignant neoplasm originating from biliary epithelial cells.
- The incidence and mortality of this cancer are rising in the world.
- It has a prevalence of 0.5-1.2/100.000 people and is Commoner in men than women
- 95% are Adenocarcinoma nature originating from the epithelial lining
- Either infiltrating nodular or diffusely infiltrating type.
Multiple risk factors
- Bile stasis-associated cholangitis
- Hepatitis B and C (C>B)
- Parasitic infections (endemic in
southeastern Asia)x 14-27-fold increase in
CC risk) leading to chronic inflammation
- Opisthorchis viverrini
- Clonorchis sinensis,
- Shistosoma Japonica
- Diabetes mellitus
- Advanced age (65% is above 65 years of age),
- Post-biliary surgery
- Biliary-enteric anastomosis
- Chronic inflammatory diseases
- Chronic typhoid carriers (x6 )
- Cryptosporidiosis cases
- Hepatic cirrhosis,
- Congenital causes (choledochal cysts, Caroli's disease,
congenital hepatic fibrosis)
- Chemical agents (thorotrast, dioxin, nitrosamines, asbestos)
- Drugs oral contraceptives, isoniazide)
- Primary Sclerosing Cholangitis x 1500 risk associated with advanced age
- Ulcerative colitis
- Intrahepatic CC
- Mass form
- Periductal-infiltrative type
- Intraductal type
- Perihilar CC (bifurcation of the main duct)
- Distal CC.
- Obstructive jaundice, often painless jaundice
- Some have abdominal pain, fatigue
- Dark urine, pale stools, weight loss
- FBC, U&E, LFT are elevated ALP
- Elevated (CA) 19-9, carcinoembryonic antigen, CA-125;
- Abdominal CT/MRI
- MR angiography, and cholangiography are used for evaluation.
- The rate of 5-year survival is about 5-10% including newly-diagnosed cases and 5-year chance of survival following potential surgery is 25-30%
- Surgery is the mainstay of treatment for early stage patients.
- Chemotherapy may have a positive effect on overall survival of patients following resection of intrahepatic cholangiocarcinoma.
- ERCP may be used to insert a stent into a blocked bile duct to relieve jaundice.
- Liver transplant is indicated in a small subset of patients.