Biliary Tract Cancer(Cholangiocarcinoma)

Posted by e-Medical PPT Saturday, July 10, 2010
Cholangiocarcinoma is a carcinoma arising in any part of the biliary tree from the small intrahepatic bile ducts to the ampulla of Vater at the distal end of the common bile duct.Cholangiocarcinoma is a relatively rare,with an annual incidence of 1–2 cases per 100,000 in the Western world.More than 90% of cholangiocarcinomas are ductal adenocarcinomas and the remainder are squamous cell tumours.
Prominent symptoms of cholangiocarcinoma include
* Jaundice is an early feature in perihilar tumours, usually with hepatomegaly.
* Abdominal pain, localised to the right upper quadrant, especially in advanced disease.
* Weight loss is variable.
* Pale-coloured stools, passage of dark urine, upper gastrointestinal pain (dull ache in the upper right quadrant), weight loss, anorexia and general malaise are common features.
* Pruritus may be the presenting symptom predating jaundice on occasions.
* Hepatomegaly.
* Splenomegaly is present if prolonged biliary obstruction has caused secondary biliary cirrhosis.
* The presence of a palpable gallbladder (Courvoisier's sign) may occur with tumours distal to the cystic duct.
The risk factors for cholangiocarcinoma include primary sclerosing cholangitis,congenital liver malformations, infection with the parasitic liver flukes.The disease is diagnosed through a combination of blood tests, imaging and endoscopy.Cholangiocarcinoma is considered to be an incurable and rapidly lethal disease unless all of its tumors can be fully resected.There is no potentially curative treatment except surgery, but unfortunately most patients have advanced and inoperable disease at the time of diagnosis.

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