Cholangiocarcinoma

Cholangiocarcinoma = malignant tumor of extrahepatic bile ducts from confluence of left/right hepatic ducts to distal common bile duct; classified as hilar/proximal, middle, distal. Primary cholangiocarcinoma is rare: 0.01-0.46% of routine autopsies, 2% of tumor autopsies, 0.3-1.8% of biliary surgeries. In Europe/USA gallbladder cancer is 1.5-5x cholangiocarcinoma; in Japan cholangiocarcinoma exceeds gallbladder cancer. M:F ~1.5-3:1; age 50-70 (also young). Etiology may relate to bile duct stones, primary sclerosing cholangitis. Treatment: surgery/radiation/chemo; prognosis poor.

Common Symptoms

Enlarged gallbladder; fever with joint swelling/pain; abdominal discomfort; diarrhea; ascites; abdominal pain; fatigue; nausea; impaired bile drainage

Causes and Pathogenesis

Etiology unclear. Risk factors: chronic cholangitis (bile acid metabolites cause epithelial dysplasia); ulcerative colitis (10x risk, onset 20-30y earlier, mean 40-45); gallstones (20-57% of cases); congenital choledochal cyst (2.5-28% cancer risk, onset 20-30y earlier; pancreaticobiliary reflux); Clonorchis sinensis infection; post-biliary surgery; thorotrast (radioactive thorium, latency 35y); PSC; HBV/HCV; K-ras codon 12 mutation (77.4%). Pathology: proximal/hilar 58%, middle 13%, distal 18%, cystic duct 4%, diffuse 7%. Macroscopic types: papillary, sclerosing, nodular, diffuse infiltrative. Histology: >95% adenocarcinoma. Routes: lymphatic (hilar/peripancreatic nodes), direct infiltration, hematogenous (lung 10-25%), perineural spread (33.3-83.4%). Staging: UICC TNM; Bismuth-Corlette types I-IV for hilar cholangiocarcinoma.

Treatment

Surgery, supportive therapy

Preventive Measures

Good mood; avoid spicy/rich food; no hard liquor; regular B-ultrasound for >40y esp women; treat cholecystitis/stones/polyps; early treatment of precancerous lesions. Primary prevention: hepatolithiasis control, regular health checks. Secondary: suspect cholangiocarcinoma in obstructive jaundice after excluding stones/hepatitis/cirrhosis; early B-ultrasound/CT/PTC/ERCP. Tertiary: timely treatment to improve cure/survival/QoL.

Department to Visit

It is recommended to visit the Medical Oncology department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.