Cholangiocarcinoma - RWellner

Cholangiocarcinoma - RWellner - Cholangiocarcinoma Rachel...

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Unformatted text preview: Cholangiocarcinoma Rachel B. Wellner MD, MPH Rachel B. Wellner MD, MPH Mount Sinai Hospital Mount Sinai Hospital Department of Surgery Department of Surgery Team III Conference Team III Conference Definition of Cholangiocarcinoma Bile duct cancers arising from ductal epithelial cells Refers to cancers arising in the intrahepatic (~5-15%), perihilar (~60-70%), or distal (extrahepatic ~25%) biliary tree Represents approx. 3% of all gastro- intestinal malignancies Definition of Cholangiocarcinoma Bismuth-Corlette Classification subdivides perihilar cholangiocarcinomas based on pattern of involvement of hepatic ducts Type I: tumors occurring below the confluence of the left and right hepatic ducts Type II : tumors reaching the confluence Types IIIA/IIIb: tumors occluding the common hepatic duct and either the right or left hepatic duct Type IV: tumors that are multicentric, or that involve the confluence and both the right or left hepatic duct Klatskin tumors occur at the bifurcation of the proper hepatic duct Risk Factors Primary Sclerosing Cholangitis 0.6-1.5% annual incidence of cholangioCA. Choledocal Cysts and Carolis Disease 0.7 % risk for first 10 years, 6.8 % risk for second ten years, and 14.3 % thereafter Clonorchis and Opisthorchis Cholelithiasis and hepatolithiasis Toxic exposure (Thorotrast) Lynch syndrome II and multiple biliary papillomatosis Pathology Adenocarcinoma (90%) Slow growing, locally invasive, mucin-producing Perineural spread, metastases uncommon Three subtypes of adenocarcinoma Sclerosing Majority of cholangiocarcinomas Characterized by an intense desmoplastic reaction Early ductal invasion leads to low resectability rates Nodular Constricting annular lesion of the bile duct Papillary Present as bulky masses occurring in the bile duct lumen Present early with biliary obstruction Highest resectability rates Clinical...
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This note was uploaded on 12/21/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Cholangiocarcinoma - RWellner - Cholangiocarcinoma Rachel...

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