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    CHOLANGIOCARCINOMA

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    Annisa Dwi Andriani
    Cholangiocarcinoma is a malignancy of the biliary tract that affects around 1 in 100,000 people per year in the US, with a slight male predominance. It is classified based on anatomical location and has various potential risk factors but an unclear etiology. Surgical resection offers the best chance for long-term survival but prognosis remains poor due to lack of early symptoms and high rates of recurrence.

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    CHOLANGIOCARCINOMA

    Uploaded by

    Annisa Dwi Andriani
    124 views26 pages
    Cholangiocarcinoma is a malignancy of the biliary tract that affects around 1 in 100,000 people per year in the US, with a slight male predominance. It is classified based on anatomical location and has various potential risk factors but an unclear etiology. Surgical resection offers the best chance for long-term survival but prognosis remains poor due to lack of early symptoms and high rates of recurrence.

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    Cholangiocarcinoma is a malignancy of the biliary tract that affects around 1 in 100,000 people per year in the US, with a slight male predominance. It is classified based on anatomical location and has various potential risk factors but an unclear etiology. Surgical resection offers the best chance for long-term survival but prognosis remains poor due to lack of early symptoms and high rates of recurrence.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    124 views26 pages

    CHOLANGIOCARCINOMA

    Uploaded by

    Annisa Dwi Andriani
    Cholangiocarcinoma is a malignancy of the biliary tract that affects around 1 in 100,000 people per year in the US, with a slight male predominance. It is classified based on anatomical location and has various potential risk factors but an unclear etiology. Surgical resection offers the best chance for long-term survival but prognosis remains poor due to lack of early symptoms and high rates of recurrence.

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    CHOLANGIOCARCINOMA

    INTRODUCTION
    CHOLANGIOCARCINOMA
    •Malignancy of the epithelium of the biliary tree.
    • The most common biliary tract malignancy.
    •Affect one in every 100,000 people per year in the United
    States.
    •Slightly more prevalent in males than females (1.3:1.0) and
    usually affects patients in the fifth to seventh decade of life.
    •Represents a diverse group of epithelial cancers united by
    late diagnosis and poor outcomes  prognosis is considered
    dismal.
    •Treatment and long-term prognosis are dependent upon
    the location of the mass.
    •Surgical treatment is the preferred option.
    DEFINITION
    CHOLANGIOCARCINOMA

    • Cholongiocarcinoma is an epithelial cell malignancy merging


    from different areas inside biliary tree

    Based on anatomical location:

    Intrahepatic Cholangiocarcinoma(iCCA)
    Perihilar Cholangiocarcinoma(pCCA)
    Distal Cholangiocarcinoma(dCCA)
    ETIOLOGY
    • Cholangiocarcinoma has developed without an identifiable
    etiology
    • Risk factors are
     primary sclerosing cholangitis (PSC)
     Viral hepatitis (HCV & HBV)
     Parasitic infections (Opisthorchis viverrini and Clonorchis
    sinensis )
     Cholelithiasis and choledocholithiasis
     Toxins (smoking, alcohol)
     Diabetes
    PATHOPHYSIOLOGY
    Cholangiocarcinoma
    assosiated with:

    INFLAMMATION GENETIC OR
    THEORY MOLECULAR THEORY
    INFLAMMATION THEORY

    Inflamm
    Chronic
    atory iNOS Nitrosati DNA Carcinog
    Inflamm
    Cytokine active ve stress damage enesis
    ation
    s
    Ac Incr
    CCA
    eas
    tiv
    INFLAMMATION THEORY
    e
    dev
    at elo
    exp
    IL- pm
    e ress
    ent
    6 ST ion
    incr
    of
    Increase Cell
    Proliferation
    AT MC
    eas
    e
    3 L1
    CHOLESTASIS

    Bile Acti ERBB2


    Tumor
    Formation
    vate
    Aci EGF Invasiveness
    HGF
    d R
    and Tumor
    Metastasis
    GENETIC OR MOLECULAR THEORY

    MUTATION OF p53

    K-ras SMAD4
    SIGN & SYMPTOMS
    Mostly asymptomatic.
    Unspecific symptoms:
     Malaise
     Abdominal pain
     Weight loss
     Hepatomegaly
     Tumor mass
     Dilated gallbladder
    Symptoms that can present on extrahepatic patient are:
    • Dark urine
    • Pruritis
    • Painless jaundice
    • Pale stools
    DIAGNOSIS
    DIAGNOSIS

    iCCA pCCA dCCA Klatskin Tumors

    Imaging Imaging Imaging

    Imaging Bismuth-Corlette system


    Tumor marker Tumor marker
    DIFFERENTIAL DIAGNOSIS
    GALLBLADDER CANCER
    HEPATOCELLULAR CARCINOMA
    CHOLANGITIS AND
    CHOLEODOCHOLITHIASIS
    MANAGEMENT
    Treatment Cholangiocarcinoma

    Surgical
    Transplantation
    Resection

    Photodynamic
    Therapy (PDT)

    Radiation
    Chemotherapy
    Therapy
    Prevention Cholangiocarcinoma

    Health Behavior Model


    changing attitude good compliance toward therapy
    PROGNOSIS
    Prognosis
    remains poor
    Intrahepatic cholangiocarcinoma Extrahepatic cholangiocarcinoma
    Stage 5-year relative survival Stage 5-year relative survival
    Localized 15% Localized 30%
    Regional 6% Regional 24%
    Distant 2% Distant 2%
    Source: American Cancer Society

    Factors that affecting patient survival have been impeded by:


    • lack of disease-specific symptoms in early stages
    • surgical resection not being an appropriate treatment option
    • high rates of tumor recurrence following surgical resection

    Good prognosis associated with:


    a. Surgery

    • modality providing the best survival prognosis for patients


    • offers the most beneficial curative option and outcome; R0 resection offers the best
    possibility of long-term survival
    Prognosis
    b. Chemotherapy or radiotherapy
    Treatment using chemotherapy or radiotherapy was found to prolong survival of ICC
    patients with unresectable tumors; ex. gemcitabine-based adjuvant chemotherapy
    c. Distal or Middle Part of Bile Duct
    • these tumors result in complete bile duct obstruction leading to early clinical
    symptoms including jaundice and cholangitis
    • location was not an independent prognostic factor
    • surgical procedure should be extended, depending on the location of the lesion closer
    to liver or pancreas in other to improve the survival
    d. Other factors
    • better liver preservation • normal ALP levels
    • lower CA19-9 levels (<100 U⁄mL) • no relapse are associated
    • less aggressive tumor conditions
    • lower bilirubin levels
    • highly differentiated tumor
    • early stages of TNM staging
    • no intraoperative blood transfusion
    Prognosis
    Poor prognosis associated with:
    • tumor differentiation
    • tumor staging
    • lymph node metastasis
    • nerve invasion
    • intravascular cancer emboli
    • the depth and distribution of infiltration
    • tumor size >2 cm
    • successful tumor resection; positive tumor resection margin
    (strongest factor)
    • location of tumor
    • presence of biliary drainage
    • microvascular invasion
    • complication

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