Cholangiocarcinoma Case Study

Decent Essays

• Introduction (Incidence, risk factors, classification, histological subtypes)
Cholangiocarcinoma is a rare malignancy that originates from the epithelial lining of the biliary ductal system. It constitutes around 3% of all gastrointestinal malignancies. There is a high variability in the estimated incidence of cholangiocarcinoma across the world, with the highest age standardized incidence rate in the northeast provinces of Thailand (113 per 100,00 person-year) as compared to the western hemisphere (0.5-1.5 per 100,00 person-year). Cholangiocarcinomas are resistant to chemotherapy and radiotherapy and surgical resection constitutes the definitive form of therapy. Poor prognosis and low 5 year survival is almost universal to theses tumors, …show more content…

Cross sectional imaging with either CT scan or MRI confirms the presence of biliary dilatation and is also used to evaluate vascular involvement, the status of the portal lymph nodes, the presence of metastatic disease and the extent of liver lobar atrophy if present. Endoscopic retrograde cholangiopancreatography (ERCP) combined with percutaneous transhepatic cholangiography define the anatomy of the biliary tree and assesses the distal and proximal extent of the tumor, respectively. It provides the ability to drain the biliary system and obtain brush cytology for pathologic diagnosis before resection. Magnetic resonance cholangiopancreatography (MRCP) has the advantage of providing detailed noninvasive images of the entire biliary tree even the segments that are obstructed by the tumor.
• Staging o Bismuth-Corelette classification: this classification is the oldest and the most widely used system in the world. It classifies tumors into 4 categories based on the longitudinal spread of the tumor along the biliary tree (Figure 3). This systems lacks information about the radial extension of the tumor and vascular involvement. o Blumgart classification: this classification has been created in the Memorial Sloan-Kettering Cancer Center. It integrates both the longitudinal and radial growth of the tumor along with vascular involvement and the …show more content…

It has been created to standardize the staging system for hilar cholangiocarcinomas in order to provide information regarding the resectability, liver transplantation and prognosis of the tumor. It includes information from the previous staging systems including: the extent of the tumor in the biliary system (B), tumor size (T), tumor form (F), involvement of the portal vein (PV), involvement of the hepatic artery (HA), liver volume remnant (V), the presence of underlying liver disease (D), the status of lymph nodes (N) and the presence of metastatic disease (M) (Figure

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