Cholangiocarcinoma

<aside> 💡 Bile duct cancer

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• Adenocarcinoma arising from the biliary tree - both intrahepatic and extrahepatic, including the ampulla of Vater

  • Up to 80% arise in the extra hepatic biliary tree.

• They account for 10% of primary liver cancers (second most common type)

• Most common site is in the perihilar region

  • This is where the right and left hepatic ducts form the common hepatic duct

  

Risk factors

<aside> 💡 Key risk factors include: Primary sclerosing cholangitis & Liver flukes (a parasitic infection)

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• BIGGEST risk factor
  • Primary sclerosing cholangitis (PSC)
• In the UK:
  • Primary sclerosing cholangitis – an autoimmune condition causing fibrosis of the bile ducts
    • Linked to ulcerative colitis
  • Anatomical abnormalities of the liver e.g. cysts, congenital abnormalities
  • Diabetes
  • Obesity
  • Chronic hepatic stones (hepatolithiasis)
• Worldwide
  • Parasitic liver flukes (A.K.A trematodes, A.K.A worms)
    • Ingested from undercooked fish
    • Worms live and lay eggs in the biliary tree, resulting in chronic inflammation.
  • Chronic Hepatitis B and C infection

Features

• Usually present with painless jaundice, similarly to pancreatic cancer
  • Obstructive jaundice
    • Pale stools
    • Dark Urine
    • Generalised itching
  • B symptoms
  • RUQ pain
  • Palpable gallbladder
  • Hepatomegaly
• Persistent biliary colic symptoms
• Anorexia, jaundice and weight loss
• Palpable mass in the RUQ
• Courvoisier’s sign (see pancreatic cancer page)
• Periumbilical lymphadenopathy (Sister Mary Joseph nodes) and left supraclavicular adenopathy (Virchow node) may be seen
• Spread is by direct invasion of the liver

Investigations