Cholangiocarcinoma
Cancer of the bile ducts, classified as intrahepatic, perihilar, or distal.
Overview
Cholangiocarcinoma (bile duct cancer) arises from the bile duct epithelium. Classified as intrahepatic, perihilar (Klatskin tumor), or distal. Surgical resection is the only curative option. Perihilar tumors are the most common and technically challenging.
Causes
- Primary sclerosing cholangitis
- Choledochal cysts
- Liver fluke infection
- Hepatolithiasis
- Chronic biliary inflammation
Risk Factors
- Age over 65
- Primary sclerosing cholangitis
- Choledochal cysts
- Parasitic infections
- Hepatitis B/C with cirrhosis
- Toxin exposure
Symptoms
Diagnosis
- MRCP/MRI
- CT with contrast
- CA 19-9 marker
- ERCP with brush cytology
- PET-CT
- Diagnostic laparoscopy
Treatment Options
Surgical Treatment
Surgical approach depends on location. Perihilar: extended hepatectomy with bile duct excision and hepaticojejunostomy. Distal: Whipple procedure. Intrahepatic: liver resection. R0 (clear margin) resection is critical for survival.
Recovery
Major liver resection: 7-14 days hospital stay. Adjuvant chemotherapy (capecitabine) for 6 months. 5-year survival: 20-40% for resected cases.
Prevention
- Treat choledochal cysts
- Surveillance for PSC patients
- Avoid raw fish (liver fluke endemic areas)
Frequently Asked Questions
Is bile duct cancer curable?
What is a Klatskin tumor?
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