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Cholangiocarcinoma
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Slides Pancreas and Biliary Tract.pdf
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Download Lecture Overview
00:01 Our topic now brings us into cholangiocarcinoma. 00:04 It is a primary tumor of the biliary epithelium. 00:09 Let's talk about risk factors. In micro, you learned about a fluke called Clonorchis sinensis, and ascariasis could be parasitic infection of the biliary tree resulting in sufficient irritation in cholangiocarcinoma. 00:26 You quickly tell me about what you’re going to find with primary sclerosing cholangitis upon imaging. Good. 00:35 Beaded appearance. Remember? Beaded appearance. 00:39 And what does your stool look like in primary sclerosing? Clay white. No pigmentation. Important. 00:47 Multiple biliary, what's known as papillomatosis, and even choledochal cyst. I just got done talking to you about how congenitally, with the choledochal cyst, that becomes dangerous because of stasis. 00:59 My topic is cholangiocarcinoma risk factors. 01:05 Exposure to thorium, a thorotrast used back in the ‘40s. 01:10 Usually, now, of historical importance, cholangiocarcinoma may be associated with FAP, HNPCC, and males. 01:20 Remember, as far as you’re concerned, familial adenomatous polyposis, 100% risk of going on to colorectal cancer, most likely left side. 01:30 Know that as being your information number one. 01:34 Information or fact number two that you want to know with hereditary nonpolyposis colorectal cancer, the patient may develop colorectal cancer on the right side. 01:44 Because of either genetic issues though,you'll never know, you could have problems with the gallbladder as well. 01:52 Diagnosis. Weight loss, jaundice and pruritus with cancer of the gallbladder. 01:58 And there’s something called a Klatskin tumor, at hilar confluence causes what's known as your palpable gallbladder, a tumor that literally is going to be at the confluence. 02:09 CT and MRCP may show ductal dilation, intra or extra-hepatic masses when dealing with cholangiocarcinoma. This cancer can be anywhere along your biliary tree. Dangerous, very dangerous. 02:24 ERCP: Histologic sampling is not sensitive. Surgery reserved for early, early cases. 02:31 Palliation, remember this, biliary duct may then become narrowed. 02:36 You need to get in there and make sure that you place a stent. 02:39 And chemo and radiotherapy, not useful. 02:42 If you don’t get in here early, your patient's dead. 02:46 Increased mortality. Cholangiocarcinoma is once again incredibly serious.
About the Lecture
The lecture Cholangiocarcinoma by Carlo Raj, MD is from the course Pancreatic and Biliary Tract Diseases: Basic Principles with Carlo Raj.
Included Quiz Questions
Which of the following is NOT a risk factor for cholangiocarcinoma?
- Biliary atresia
- Choledochal cysts
- Parasitic infections affecting the biliary system
- Primary sclerosing cholangitis
- Multiple biliary papillomatosis
Which of the following parasites is a risk factor for cholangiocarcinoma?
- Clonorchis sinensis
- Entamoeba histolytica
- Echinococcus granulosus
- Schistosoma mansoni
- Fasciola
Which of the following syndromes does NOT predispose to cholangiocarcinoma?
- Cowden syndrome
- Familial adenomatous polyposis
- Hereditary non-polyposis colon cancer syndrome
- Caroli's syndrome
- Lynch syndrome
Which statement BEST describes a Klatskin tumor?
- Primary cholangiocarcinoma occurring at the junction of the right and left hepatic bile ducts
- Metastatic cholangiocarcinoma occurring at the junction of the right and left hepatic bile ducts
- Pancreatic adenocarcinoma occurring at the junction of the right and left hepatic bile ducts
- Pancreatic adenocarcinoma occurring at the junction of the 2nd part of the duodenum and the common bile duct
- Hepatic adenocarcinoma occurring at the junction of the right and left hepatic bile ducts
Which of the following statements regarding cholangiocarcinoma is TRUE?
- Surgery is beneficial if the tumor is detected early.
- Chemotherapy is most useful in the treatment of cholangiocarcinoma.
- Stent placement is not helpful in palliation for patients with cholangiocarcinoma.
- Cholangiocarcinoma is not an aggressive tumor.
Author of lecture Cholangiocarcinoma
Carlo Raj, MD
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