Cholangiocarcinoma

Cholangiocarcinoma is a malignant tumor of the extrahepatic bile duct from the hepatic duct confluence to the distal common bile duct. It is divided into hilar/proximal, middle and distal types. Primary cholangiocarcinoma is rare (0.01-0.46% of autopsies, 2% of tumor autopsies, 0.3-1.8% of biliary surgeries). In Europe/US gallbladder cancer is 1.5-5x more common; in Japan cholangiocarcinoma predominates. M:F ratio 1.5-3.0; age 50-70, but younger patients occur. Causes may relate to bile duct stones and primary sclerosing cholangitis. Treatment includes surgery, radiotherapy, chemotherapy; prognosis is poor.

Common Symptoms

Enlarged gallbladder; fever with joint pain; abdominal discomfort; diarrhea; ascites; abdominal pain; fatigue; nausea; biliary obstruction

Causes

Chronic inflammation is the foundation: long-term stimulation by bile acid metabolites causes epithelial atypia. Ulcerative colitis patients have 10x risk, 20-30 years earlier onset (mean 40-45). 20-57% have gallstones. Congenital choledochal cysts have 2.5-28% cancer risk, 20-30 years earlier. Clonorchis sinensis infection is associated. Thorotrast (radioactive thorium dioxide) exposure causes cancer 10 years earlier with 35-year latency. Primary sclerosing cholangitis and hepatitis B/C are associated. K-ras codon 1 mutation rate reaches 77.4%. Distribution: proximal/hilar 58%, middle 13%, distal 18%, cystic duct 4%, diffuse 7%. Gross types: papillary, sclerosing, nodular, diffuse infiltrative. Histology: >95% are adenocarcinoma; rare squamous, mucinous, cystadenocarcinoma. Spread: lymphatic (most common), direct invasion, hematogenous (lung 10-25%), perineural (33-83%). TNM/UICC staging; Bismuth-Corlette hilar types I-IV.

Treatment

Surgery; supportive care

Prevention

1. Maintain positive mood, healthy diet, avoid spicy/high-fat foods and hard liquor. 2. People over 40 (especially women) should have regular ultrasound; follow up cholecystitis, stones or polyps. 3. Actively treat precancerous lesions. 4. Primary prevention: hepatolithiasis control and regular health checks. Secondary: suspect cholangiocarcinoma in obstructive jaundice after excluding stones/hepatitis/cirrhosis; perform ultrasound/CT/PTC/ERCP early. Tertiary: treat promptly after diagnosis to improve cure rate, survival and quality of life.

Recommended Department

It is recommended to visit the oncology department; before the visit you may first book an appointment and connect with experts through this platform.

Warm reminder: The above information is provided for health education reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek care at a regular hospital in time.