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.