by Carlo Raj, MD

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    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.

    Included Quiz Questions

    1. Biliary atresia
    2. Choledochal cysts
    3. Parasitic infections affecting the biliary system
    4. Primary sclerosing cholangitis
    5. Multiple biliary papillomatosis
    1. Clonorchis sinensis
    2. Entamoeba histolytica
    3. Echinococcus granulosus
    4. Schistosoma mansoni
    5. Fasciola
    1. Cowden syndrome
    2. Familial adenomatous polyposis
    3. Hereditary non-polyposis colon cancer syndrome
    4. Caroli's syndrome
    5. Lynch syndrome
    1. Primary cholangiocarcinoma occurring at the junction of the right and left hepatic bile ducts
    2. Metastatic cholangiocarcinoma occurring at the junction of the right and left hepatic bile ducts
    3. Pancreatic adenocarcinoma occurring at the junction of the right and left hepatic bile ducts
    4. Pancreatic adenocarcinoma occurring at the junction of the 2nd part of the duodenum and the common bile duct
    5. Hepatic adenocarcinoma occurring at the junction of the right and left hepatic bile ducts
    1. Surgery is beneficial if the tumor is detected early.
    2. Chemotherapy is most useful in the treatment of cholangiocarcinoma.
    3. Stent placement is not helpful in palliation for patients with cholangiocarcinoma.
    4. Cholangiocarcinoma is not an aggressive tumor.

    Author of lecture Cholangiocarcinoma

     Carlo Raj, MD

    Carlo Raj, MD

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