Internal Medicine

0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

Cholangiocarcinoma 301

➣false negative cytology due to scirrhous nature of tumor; confir-

mation of tissue diagnosis can be difficult.

➣allows stenting of the area

■Percutaneous cholangiography

➣may be needed in more proximal tumors

■MRCP, PET, endoscopic ultrasound, or intraductal ultrasound tech-

niques undergoing development

differential diagnosis

■choledocholithiasis

■bile duct stricture after surgery

■primary sclerosing cholangitis

■metastases that obstruct the bile ducts

■chronic pancreatitis

■pancreatic carcinoma

management

What to Do First

■establish diagnosis by imaging studies, cholangiography, and/or CA

19–9

■assess patient’s ability to undergo attempted resection

General Measures

■support nutrition

■provide biliary drainage

specific therapy

■chemotherapy ineffective

■radiation results variable, may double the length of survival

■internal radiation or brachytherapy undergoing study

■surgery: only chance for cure

➣25% resectable

➣20% distal common bile duct, 25% mid-bile duct, 50% upper bile

duct

➣tumor at the bifurcation of the common hepatic duct =

Klatskin’s tumor

➣1% entirely intrahepatic.

➣distal tumors: Whipple resection, small tumor best chance of

long-term survival and highest rate of resectability; up to a 50%

5-year survival.

➣middle third tumors: slightly lower resectability.