Leukemia (Blood Cancer)

Cholangiocarcinoma (Bile duct Cancer)

Hi in this blog I’m going to be going through Cholangiocarcinoma is a type of cancer that originates in the bile ducts the majority are adenocarcinomas it may affect the bile ducts inside the liver the intra-hepatic ducts or the bile ducts outside the liver the extrahepatic ducts the most common site is the perihilar region which is where the right and the left hepatic duct have joined to become the common bile duct just after they leave the liver the key risk factors for cholangiocarcinoma to remember are primary sclerosing cholangitis and liver flukes which are a parasitic infection a tom tip for you patients with ulcerative colitis are at risk of developing primary sclerosing cholangitis patients that have primary sclerosing  cholangitis are at risk of developing cholangiocarcinoma about 10 to 20 percent when it comes to cholangiocarcinoma primary sclerosing cholangitis is the key risk factor that's worth remembering for your exams the other notable cause is parasitic infection with liver flukes which are found in various parts of southeast Asia and Europe let's talk about the presentation obstructive jaundice is the key presenting feature to remember obstructive jaundice is associated with pale stools dark urine and generalized itching other non-specific signs and symptoms of cholangiocarcinoma include unexplained weight loss right upper quadrant pain a palpable gallbladder which is swollen due to an obstruction in the duct that's distal to the gallbladder causing a back pressure of bile building up inside the gallbladder and finally hepatomegaly Courvoisier’s law states that if there's a palpable gall bladder and the patient has jaundice the diagnosis is unlikely to be gallstones the cause is usually cholangiocarcinoma or pancreatic cancer a tom tip for you painless jaundice should make you think of cholangiocarcinoma or cancer of the head of the pancreas pancreatic cancer is more common so this is likely to be the answer in your exams let's talk about investigations the diagnosis is based on imaging for example a CT or MRI scan plus histology from a biopsy of the lesion a staging ct scan involves a full CT of the thorax abdomen and pelvis or CT tap is used to look for metastasis and other cancers the tumor marker to remember for cholangiocarcinoma is ca19-9 and ca stands for carbohydrate antigen and this is a tumor marker that may be raised in cholangiocarcinoma it's also raised in pancreatic cancer and a number of other malignant and non-malignant conditions so it's not very specific if the patient has evidence of obstruction for example painless jaundice a magnetic resonance Cholangio-pancreatography or MRCP imaging may be used to visualize the biliary system in detail and assess any obstruction if there is obstruction in place an endoscopic retrograde Cholangio-pancreatography or ERCP procedure can be used to put a stent in and relieve the obstruction and it can also be used to obtain a biopsy from the tumor finally let's talk about management will be decided at a multi-disciplinary team or MDT meeting curative surgery may be possible in early cases and it may be combined with radiotherapy and chemotherapy however in most cases curative surgery is not possible palliative treatment may involve stents inserted to relieve any biliary obstruction surgery to improve symptoms for example bypassing ability obstruction palliative chemotherapy palliative radiotherapy and end-of-life care with symptom control. 

Thanks. 

Muhammad Fahad Siddique

0092-300-2982069

raomfahadsiddique@gmail.com