Biliary Tract and Gallbladder Neoplasia Flashcards Preview

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Flashcards in Biliary Tract and Gallbladder Neoplasia Deck (17)
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1
Q

What are the locations of cholangiocarcinoma?
What are their relative incidences?

A

Intrahepatic (5%)
Perihilar (65%)
Extrahepatic (30%)

2
Q

What is the epidemiology of cholangiocarcinoma?

(Relative incidence of malignancy, age)

A

3% of GI malignancies
Typically age of dx: 50-70
PSCs and biliary cysts results in younger age of dx

3
Q

What are risk factors for cholangiocarcinoma?

A

PSCs (30% of cases)
Biliary cysts
Biliary parasitosis
Thorotrast - Contrast agent
Cirrhosis/liver damage not at all required

4
Q

What types of biliary cysts are there?
Which one predispose to cholangiocarcinoma?

A

Classification (Stated we just have to understand they can occur in different spots):

Type I: Extrahepatic only
Type IV: Multiple cysts, extrahepatic
Type V: Intrahepatic only, Caroli’s disease

I, II, IV predispose to cholangiocarcinoma

5
Q

What biliary parasites are there? Where are they located?

A

Clonorchis sinensis (Chinese liver fluke)

Far east and Russia
Asymptomatic, cholangitis
Growth cycle

Sheep/dogs natural host
Snail takes up egg and then deposits intermediate parasite in water
Transferred via water consumption

Opisthorchiasis (liver fluke of cats, dogs, and fish-eating mammals)

Southeast Asia and in Central and Eastern Europe

Similar to Clonorchis sinensis

6
Q

What does cholangiocarcinoma lead to?
How does it manifest?

A

Leads to obstruction or severe narrowing

Extrahepatic: symptomatic from biliary obstruction
Jaundice, abdominal pain, pruritus, weight loss, fever

Intrahepatic: Less likely to be jaundiced, abdominal pain and weight loss
Half of draining still works

7
Q

What lab tests are involved for cholangiocarcinoma?
What imaging/diagnostic studies?

A

Reduction of alk phos
Jaundice
Increased direct bilirubin
Carbonic Anhydrase (CA) 19-9 of limited value due to false positives and negatives

CT, MRI, ERCP (Necessary to confirm)

8
Q

What is the histiological types of cholangiocarcinoma?

A

>90% adenocarcinoma
Squamous cell carcinoma and others exist

9
Q

What is the treatment for cholangiocarcinoma?
What is the prognosis if not treated?

A

Curative Surgery

Distal: Whipple procedure
Resect piece of bile duct and pancreatic head
Reinsert bile duct and pancreas to small intestine

Perihilar: Bile duct resection, hepatic lobectomy

Intrahepatic: Hepatic resection

Liver transplant for hilar cholangiocarcinoma

Palliative care

5-10%, 5-year survival

10
Q

What is the epidemiology of gallbladder cancer?

(Histiology, relative incidence, fatality, sex)

A

Adenocarcinoma; 75% of cases
Uncommon, highly fatal
Women have 2-6x risk than men

11
Q

What are the risk factors?

A

Porcelain gallbladder
Gallbladder polyps
Cholelithiasis

12
Q

What is a porcelain gallbladder?
What mechanisms result in its formation?
Epidemiology?
What elevates the risk?

A

Chronic cholecystitis with intramural calcification of gallbladder wall

Possible mechanisms:
Gallbladder wall injury from irritation of gallstones
Bile stagnation and mucosal precipitation of calcium carbonate salts
Deposition of lime salts from chronic inflammation

Uncommon but 5:1 in females

Incomplete calcification appears worse risk

13
Q

What are the different causes and types of gallbladder polyps?
What likely determines the transformation potential?

A

Cholesterol: abnormal deposition of TGs, cholesterol precursors and esters into gallbladder mucosa
Inflammatory: Granulation and fibrous tissue with plasma cells and lymphocytes
Adenomas: Benign glandular tumors with potential for malignancy

Likelihood of transformation related to size (none less than 12 mm in series)

14
Q

What percent of people have cholelithiasis?
What percent of gallbladder cancer patients have cholelithiasis?
What attribute fof cholelithiasis might indicated cancer?

A

0.5-3% incidence
70-90% of patients with gallbladder cancer have cholelithiasis
Size possibly indicative

15
Q

What are the four typical presentations of gallbladder cancer?

A

Incidental on imaging (Best case)
Found intraoperatively during cholecystectomy for presumed benign disease
Found incidentally on pathologic examination: Most common
Symptomatic: Pain, anorexia, nausea, vomiting, jaundice; Very poor prognosis

16
Q

What is the prognosis and treatment of gallbladder cancer?

A

Stage dramatically determines
Very poor after stage I
Easy for metastatic spread due to the proximity

Surgery is only option for cure

17
Q
A