For patients with advanced disease, systemic therapy should be considered either as definitive therapy (i.e., for patients with unresectable disease) or as adjuvant therapy (i.e., for patients with resected disease and adverse pathological features such as lymph node metastasis). Unfortunately, chemotherapy has minimally proven benefit in CCA and likely would not be administered in a remote tropical area [1]. In addition, radiation or other intra-arterial therapies are not curative in nature, and these therapies are unlikely to be feasible in a remote tropical setting [2].

While cholangiocarcinoma can be managed with scant resources, transferring a patient with a possible diagnosis of CCA to an area with more available resources may be appropriate. In addition, transferring the patient for appropriate surgical resection is also appropriate if the surgeon in the remote setting is not comfortable with the complexity of surgical resection associated with CCA. CCA traditionally requires extensive workup and complex surgical management. As such, both the diagnosis and surgical management of CCA in a tropical setting with limited resources can be quite challenging.