Resection margin status of bile duct is highly correlated with survival in cholangiocarcinoma. A few referral centers have reported good results, but no robust, riskadjusted outcomes data. Cholangiocarcinoma, also known as bile duct cancer, is a type of cancer that forms in the bile ducts. The prognosis of patients with cholangiocarcinoma is unsatisfactory.
Therefore, evaluation of prognostic factors and establishment of new therapeutic strategies are needed to improve their longterm survival. Symptoms of cholangiocarcinoma may include abdominal pain, yellowish skin, weight loss, generalized itching, and fever. Atlas of advanced operative surgery 1st edition pdf. Distal cholangiocarcinomas make up 2 to 3 of every 10 bile duct cancers. Because these bile ducts are outside of the liver, these cancers are grouped with perihilar cancers as extrahepatic cholangiocarcinoma. Cholangiocarcinomas are deadly and require complex decisions as well as major surgery. Cholangiocarcinoma cc is a malignant disease of epithelial cells of the biliary tree. Three most known formations or types of cholangiocarcinoma are intrahepatic, extrahepatic and perihilar cholangiocarcinoma. Staging of cholangiocarcinoma is possible by examining the lymph nodes attached to the biliary system. Regional lymph node of distal bile duct is defined to be the lymph node along the porta hepatis, hepatic artery, anterior and posterior to the head of pancreas, and the lymph node along superior mesenteric artery. Distal cholangiocarcinoma and pancreas adenocarcinoma.
Despite recent advances, to date there is still no established targeted therapeutic approach available. Cholangiocarcinoma is classified by icd codes byintra or extrahepatic location, icd9 155. Survival and quality of life of cholangiocarcinoma. In general, curative surgery for distal cholangiocarcinoma requires pd.
This article seeks to provide the reader with a framework and algorithmic approach to the evaluation of abnormalities involving the distal cbd and ampulla, including an emphasis on the use of multiplanar reformations and 3d imaging, the morpho. Novel biomarkers distinguishing pancreatic head cancer from distal cholangiocarcinoma based on proteomic analysis. This is a pdf file of an unedited manuscript that has been accepted for publication. More recently, the term cholangiocarcinoma has been used to designate bile duct cancers arising in the intrahepatic, perihilar, or distal extrahepatic biliary tree, exclusive of gallbladder and ampulla of vater. Winner of the standing ovation award for best powerpoint templates from presentations magazine. Introduction the terms cholangiocarcinoma and bile duct cancer are often used interchangeably. Benefits and limitations of middle bile duct segmental. The distal common bile duct cbd and ampulla are extremely difficult sites to evaluate on ct. The earlier the diagnosis of cholangiocarcinoma is made, the better the chances of 5year survival. Clinical diagnosis and staging of cholangiocarcinoma.
Andrew p loehrer, md, michael g house, md, facs, attila nakeeb, md, facs, e molly kilbane, rn, henry a pitt, md, facs background. Distal cholangiocarcinoma as seen on mrcp this mrcp image, obtained without having to opacify the bile ducts, demonstrates a circumferential narrowing of the distal common bile duct cbd, arrow due to a focal distal cholangiocarcinoma. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect. Management of patients with suspected cholangiocarcinoma. Approximately 5 to 10 percent of cholangiocarcinomas are intrahepatic. More recently, the term cholangiocarcinoma has been used to refer to bile duct cancers arising in the intrahepatic, perihilar, or distal extrahepatic biliary tree, exclusive of the gallbladder or ampulla of vater.
Distal cholangiocarcinoma, journal of surgical oncology. Nonsurgical therapeutic agents are urgently needed, as most patients are noneligible to surgical resection. Vietnam veterans the cholangiocarcinoma foundation. Documentation is available in the research files for both liver fluke and herbicide exposure. The differentiation between pancreatic head cancer phc and distal cholangiocarcinoma dcc can be challenging because of their anatomical and histopathological similarity. Many people with this disease also have inflammation of the large. Staging distal cholangiocarcinoma distal cholangiocarcinomas are found further down the bile duct, closer to the small intestine and pancreas. Hilar cholangiocarcinoma, sometimes referred to as a klatskin tumor, is a rare neoplasm arising proximal to the confluence of the cystic and common hepatic ducts. Distal bile duct cancer is the most common type of bile duct cancer after intrahepatic bile duct cancer. Initial stage symptoms of distal cholangiocarcinoma include cholangitis, jaundice, etc. Cholangiocarcinoma cca is the most common biliary tract malignancy and the second most common primary hepatic malignancy. Consent i give the cholangiocarcinoma foundation ccf the right and permission to publish, reproduce andor distribute my poster in any manner on a royaltyfree basis. Biliary tract cancer comprises cholangiocarcinoma may be suspected if abdominal ultrasound demonstrates local dilation of intrahepatic ducts or isolated dilation of the biliary tree inside one lobe of the liver.
Management of patients with suspected cholangiocarcinoma clinical guidelines july 2014. Cholangiocarcinomas cccs are malignancies of the biliary duct system that may originate in the liver and extrahepatic bile ducts, which terminate at the ampulla of vater. Nevertheless, the prognosis of distal cholangiocarcinoma is better when compared to other. Cholangiocarcinoma ppt free download as powerpoint presentation. However, this classification less clinically useful than the commonly adopted. Introduction cholangiocarcinoma has been used to refer to bile duct cancers arising in the intrahepatic, perihilar, or distal extrahepatic biliary tree, exclusive of gallbladder or ampulla of vater arise from the epithelial cells of the bile ducts intrahepatic type originate from either small intrahepatic ductules peripheral. Guidelines guidelines for the diagnosis and treatment of. Intrahepatic, perihilar and distal cholangiocarcinoma. Efficacy of neoadjuvant chemoradiation, followed by liver transplantation, for perihilar cholangiocarcinoma at 12 us centers sarwa darwish murad, w. Antipdl1 therapy prevents cancer cells from evading the. Vietnam veterans were exposed to two different risk factors regarding developing cholangiocarcinoma due to their service in vietnam. Of 81 patients with extrahepatic bile duct cancer treated from 1983 to 1992, those with proximal duct lesions n 56 underwent rt andor resection or palliative care, and those with distal lesions n 25 underwent resection with or without rt. Distal cholangiocarcinoma distal cholangiocarcinoma liu, katherine 20070301 00.
Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Because of the softness of the pancreatic parenchyma and narrowness of the pancreatic duct, many patients with distal bile duct cancer who underwent pd suffered from postoperative pancreatic. The obstructing tumor is causing dilation of the cbd. The aim of this study was to identify useful prognostic factors for patients with intrahepatic, hilar, and distal cholangiocarcinoma. Abnormalities of the distal common bile duct and ampulla. Cholangiocarcinoma cca is the most common biliary malignancy and the second most common primary hepatic malignancy after hepatocellular carcinoma hcc. However, there are no biomarkers for the differential diagnosis of phc and dcc.
Advance your surgical expertise with atlas of advanced operative surgery. Depending on the location, the who identifies two main categories. Perihilar cholangiocarcinoma pcca describes tumors located between the secondary branches of the right and left hepatic ducts and the common hepatic duct proximal to the cystic duct origin. Time for collaborative studies, world journal of surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. The cause of the inflammation is not usually known. Ppt cholangiocarcinoma powerpoint presentation free to. Primary biliary tract malignancies affect one in every 100,000 people per year in the united states. Novel biomarkers distinguishing pancreatic head cancer. It is the most common form of the disease, accounting for more than half of all cases. Intrahepatic icc and extrahepatic cholangiocarcinoma ecc. Cholangiocarcinoma cca may arise in the intra or extrahepatic biliary tract and is associated with a poor prognosis. When crosssectional imaging reveals a locally advanced distal cholangiocarcinoma, it is necessary to obtain a pathologic diagnosis usually cytologic. Distal cholangiocarcinoma is defined locally advanced stage iii when has spread to the portal vein and the hepatic artery, or when has spread to the superior mesenteric artery. According to the anatomical location, ccas are subclassified into intrahepatic icca.
Cholangiocarcinoma is the most common primary malignancy of the biliary tract. Distal cholangiocarcinoma has a favorable prognosis compared with pdac, yet current adjuvant therapy regimens are only associated with improved survival in pdac, not dc. Pdf novel biomarkers distinguishing pancreatic head. Nevertheless, the prognosis of distal cholangiocarcinoma is better when compared to other two types of bile duct cancer. Conclusions distal cholangiocarcinoma and pancreatic ductal adenocarcinoma are distinct entities. Survival and quality of life of cholangiocarcinoma patients. Ccas are heterogeneous biliary epithelial tumours that are classified into intrahepatic icca, perihilar pcca, and distal dcca subtypes based on their anatomic location within the. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext.
Followup was available 3114 months median, 28 months. This new resource picks up where other surgical references leave off, providing highly visual, stepbystep guidance on more than 100 advanced and complex procedures in both general and subspecialty areas. Staging distal extrahepatic cholangiocarcinoma the. This is an important problem, because the distinction has important implications for the treatment of these malignancies. The risk factors are exposure to liver flukes and dioxin, which is in agent orange. The british society of gastroenterology guidelines on the management of cholangiocarcinoma were originally published in 2002. Diseases in the liver or bile ducts primary sclerosing cholangitis expand a condition in which inflammation of the bile duct cholangitis leads to the formation of scar tissue sclerosis and an increased risk of cholangiocarcinoma. The latter two subtypes were previously grouped as extrahepatic cca but are now considered distinct entities based upon. Perihilar cholangiocarcinoma also known as a klatskin tumor begins in an area called the hilum, where two major bile ducts join and leave the liver. The remaining cases are classified as distal cholangiocarcinomas, which begin in bile ducts outside the liver. Distal cholangiocarcinoma dcca describes tumors of the common bile duct cbd, up to but not including the ampulla vateri. In both peripheral and hilar cholangiocarcinoma, biliary ducts distal to the obstruction common hepatic duct and common bile duct are not dilated.