Cholangiocarcinoma
Cholangiocarcinoma is the most common cancer arising from the bile ducts. It can occur at the liver hilum, in the lower common bile duct, or within the intrahepatic bile ducts. Among these, hilar cholangiocarcinoma is the most frequent type.
Risk Factors for Cholangiocarcinoma:
- Choledochal cyst
- Infection with Clonorchis sinensis
- Hepaticolithiasis (stones in the intrahepatic ducts)
- Primary sclerosing cholangitis
- Previous biliary–enteric drainage surgeries
Symptoms:
- Painless jaundice
- Itching
- Loss of appetite and weight loss
- Fever and abdominal pain if cholangitis develops
Diagnosis:
Suspicion arises when USG, CT, or MRCP shows bile duct obstruction or a mass near the common bile duct.
For confirming the diagnosis, options include:
- EUS-guided FNA
- ERCP brush cytology
- SpyGlass cholangioscopy with biopsy
Treatment:
- Surgical removal is the preferred treatment when the tumor is resectable.
- For unresectable hilar tumors, a newer approach is chemo-radiotherapy followed by liver transplantation.
- In advanced disease, ERCP with stent placement helps relieve jaundice, itching, and fever for palliative care.