Biliary Cancer
Background
What common condition is linked with increased risk for gallbladder cancer?
Cholelithiasis increases the risk for gallbladder cancer (presumably via chronic inflammation).
What 2 medical conditions are most associated with increased incidence of cholangiocarcinoma?
Pts with primary sclerosing cholangitis or ulcerative colitis have an increased incidence of cholangiocarcinoma.
What is the most common histology for gallbladder cancer?
Most gallbladder cancers are adenocarcinomas.
What pathologic subtype of gallbladder cancer and cholangiocarcinoma is associated with an improved prognosis?
Papillary adenocarcinoma is associated with an improved prognosis compared with other gallbladder adenocarcinomas and cholangiocarcinomas.
What % of gallbladder cancer presents with DM? What 2 sites are most common?
40%–50% of gallbladder cancer presents with DM. Liver and peritoneal involvement is most common.
What % of gallbladder cancer presents with LN mets? What 4 nodal regions are most commonly involved?
45% of gallbladder cancer presents with nodal mets. The cystic, hilar, pericholedochal, and celiac nodes are most commonly involved. Note that the cystic nodes drain to the pericholedocal nodes, which drain to the retropancreaticoduodenal nodes.
What subtype of adenocarcinoma is the most common form of cholangiocarcinoma?
Mucin-producing adenocarcinoma is the most common form of cholangiocarcinoma.
What is the most common route of spread for gallbladder cancer and cholangiocarcinoma?
Gallbladder cancer and cholangiocarcinoma most commonly spread by direct extension (to the liver for gallbladder cancer and along the biliary tree for cholangiocarcinoma).
What are the 3 subsites for cholangiocarcinoma?
Cholangiocarcinoma is divided into intrahepatic, extrahepatic, and hilar (i.e., Klatskin tumors) subsites.
What % of cholangiocarcinomas present with LN mets?
30%–50% of cholangiocarcinomas present with nodal mets.
What % of cholangiocarcinomas present with DM?
30% of cholangiocarcinomas present with DM.
What are the 2 most common presenting Sx for pts with gallbladder cancer or cholangiocarcinoma?
Jaundice and abdominal pain are the 2 most common presenting Sx for pts with gallbladder cancer or cholangiocarcinoma.
Gallbladder cancer is most commonly diagnosed following what procedure?
Gallbladder cancer is most commonly diagnosed following cholecystectomy for presumed benign Dz.
What is the preferred method of tissue Dx for cholangiocarcinoma?
Endoscopic retrograde cholangiopancreatography brushings or CT-guided FNA Bx are preferred methods for tissue Dx of cholangiocarcinoma. However, surgical exploration may be required for Dx in the setting of extensive sclerosis.
During surgical exploration, what type of Bx is preferred for the Dx of cholangiocarcinoma?
During surgical exploration, FNA is preferred over incisional Bx to Dx cholangiocarcinoma (b/c of increased risk of peritoneal failure or wound implant following incisional Bx).
Workup/Staging
What 2 serum markers should be sent for suspected cholangiocarcinoma?
CEA and CA 19-9 may have value as tumor markers for cholangiocarcinoma.
What 3 imaging studies are typically performed to workup suspected gallbladder cancer or cholangiocarcinoma?
RUQ US, contrast-enhanced CT (preferably multiphase), and magnetic resonance cholangiopancreatography (MRCP) are typically performed for pts with suspected gallbladder cancer or cholangiocarcinoma.
On contrast-enhanced CT of the liver, how can hepatocellular carcinoma and intrahepatic cholangiocarcinoma be distinguished?
On contrast-enhanced CT of the liver, hepatocellular carcinoma usually enhances during the arterial phase, while cholangiocarcinoma may show delayed enhancement.
What is the imaging study of choice for extrahepatic cholangiocarcinoma?
MRCP is the imaging study of choice for extrahepatic cholangiocarcinoma, as it has improved the ability to define tumor extent and LN involvement.
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