Biliary Tract & Gallbladder Neoplasms - Franco Flashcards
Where could a cholangiocarcinoma appear?
What percentage of cases does each location represent?
Intrahepatic- 5%
Perihilar-65%
Distal Extrahepatic-30%
What percentage of GI cancers are cholangiocarcinomas?
What age do patients typically present?
3% of GI malignancies
50-70
can present earlier in PSC or biliary cysts
What is a risk factor for cholangiocarcinoma? (VERY general)
What are specific risk factors for cholangiocarcinoma?
Damage to the bile ducts
biliary cysts
PSC
biliary parasitosis
thorotrast
What is primary sclerosing cholangitis?
Why does it cause damage to the biliary ducts?
Narrowing of the biliary tree
stones form behind the narrowed areas, causing damage and scarring to the bile duct
What are biliary cysts?
How do they damage the bile ducts?
dilatations in the biliary tree
They don’t; apart from increasing risk cholangiocarcinoma, they are benign
What are the different classfications of biliary cysts?
Which biliary cyst types increase risk of cholangiocarcinoma?
- Type 1- extrahepatic cysts
- Type 2- pouch off bile duct
- Type 3-Intraduodenal cyst
- Type 4-Extrahepatic and Intrahepatic
- Type 5- Intrahepatic only
Types 1, 2, and 4 increase the risk of cholangiocarcinoma
What is biliary parasitosis?
How does it damage the bile duct?
Chronic infection with liver flukes
Inflammation and presumably eosinophil/mast cell degranulation
What different organisms can cause biliary parasitosis?
Where are these organisms endemic?
- Clonorchis sinensis- Chinese Liver fluke
- Far East and Eastern Russia
- Opisthorchiasis- Liver fluke from dogs, cats
- Southeast Asia, Central Europe, and East Europe
What would you expect to see in the following tests for a patient with cholangiocarcinoma?
Alkaline Phosphatase
Conjugated Bilirubin
Unconjugated Bilirubin
Physical Appearance
Increased alk phos
Increased conjugated bilirubin
Normal unconjugated bilirubin
jaundice
Histologically, are cholangiocarcinomas more likely to be adenocarcinomas or squamous cell carcinomas?
Surprisingly, adenocarcinomas!
How would clinical presentation change if the cholangiocarcinoma was extrahepatic vs intrahepatic?
- Intrahepatic
- less likely to be jaundiced (bile can still drain from some ducts)
- Extrahepatic
- jaundice (common bile duct is more likely blocked)
- pruritis (see above)
- fever (cholangitis from blockage)
What is carbonic anhydrase 19-9?
How does it relate to cholangiocarcinoma?
enzyme that is elevated in response to gallbladder injury
it is sometime elevated in cholangiocarcinoma, but has many false positives and false negatives
How is cholangiocarcinoma treated?
Surgery
- Distal- Whipple procedure
- Perihilar- bile duct resection, hepatic lobectomy
- Intrahepatic- hepatic resection
- hilar- liver transplant
What type of cancer is gallbladder cancer histologically?
How common is it?
Who gets it?
adenocarcinoma (just like cholangiocarcinoma)
VERY rare (and VERY fatal)
women 2-6 times as often as men
What are some risk factors for gallbladder cancer?
- porcelain gallbladder (fusion of gallstones to coat the gallbladder)
- Gallbladder polyps (polyps often mutate to cancer)
- Cholelithiasis (stones irritate the lining)
