Biliary Tumors Cholangiocarcinoma and Cancer of the Gall Bladder

Biliary Tumors Cholangiocarcinoma and Cancer of the Gall Bladder
By: Larry Pennington, MD

Cholangiocarcinoma
Etiology
Ulcerative Colitis
Thorotrast Exposure
Sclerosing Cholangitis
Typhoid Carrier
Choledochal Cysts
Adult Polycystic Kidney Disease
Hepatolithiasis
Liver Flukes

Papillomatosis of Bile Ducts
Cholangiocarcinoma
Extra-hepatic: Distribution
Diagnosis and Initial Workup
Intra and Extra-hepatic Cholangiocarcinoma
Cholangiocarcinoma Intra-hepatic Disease
* Suspicious mass on CT. Quadruple phase CT with 0.5 cm cuts through the liver and portal hepatitis. Consider CTA reconstruction.
* Bx
* If adenoncarcinoma: look for primary with a chest CT and upper/lower endoscopy.
* Colon, pancreas, and stomach are common primary sites.

Cholangiocarcinoma Intra-hepatic Disease-Surgery/Ablation
* Extent of surgical therapy is determined by the location, hepatic function, and underlying cirrhosis.
* Anatomic resections have lowest recurrence rates. However nonanatomic resection increases potential surgical candidates and improves survival.
* Hepatic devascularization prior to resection is preferred
* Ablative therapy gives good local control.

Child’s Classification
Intra-hepatic Disease: Extent of Resection
Intra-hepatic Disease
Representative Case
MRCP of Extra-hepatic Cholangiocarcinoma at the Bifurcation
Klatskin tumor
Cholangiocarcinoma Extra-hepatic
Cholangiocarcinoma Pathology
Extra-hepatic Disease: Surgical Therapy
ERCP: Distal CBD Cancer
Ca of CBD Bifurcation
Node Dissection in Bile Duct Excision
Roux-en-Y Hepaticojejunostomy
Extra-hepatic Disease: Positive Margins or Unresectable
Extra-hepatic Disease: Unstentable
* Bypass if possible
* If not use proximal decompression and feeding jejunostomy
* Chemotherapy/Radiation Therapy/Brachy therapy as tolerated or clinical trial.
Cholangiocarcinoma Prognosis
* Best Result are with distal CBD tumors completely excised. Cure = 40%
* Incomplete resection plus radiation gives a median survival of 30 m.
* Stenting plus chemo/radiation gives a median survival of 17 to 27m
* Those stented alone live only a few months

Cancer of the Gall Bladder
Gall Bladder Cancer
Presentation (1)
Presentation 2
PET Scan and Cholangiocarcinoma
Sclerosing type of Cholangiocarcinoma
Cytological Brushing of Cholangiocarcinoma

Biliary Tumors Cholangiocarcinoma and Cancer of the Gall Bladder.ppt