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    CHOLANGIOCARCINOMA

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    PremaKurnia
    Cholangiocarcinoma is a malignancy of the biliary tract that affects around 1 in 100,000 people annually in the US. It is more common in males over 50 and has a poor prognosis. Surgical resection offers the best chance of survival but many are unresectable at diagnosis. Risk factors include primary sclerosing cholangitis, viral hepatitis, parasites, gallstones, smoking and alcohol. Genetic mutations and chronic inflammation are believed to play a role in tumor development. Symptoms are often vague and diagnosis relies on imaging and tumor markers. Treatment involves surgery, radiation, chemotherapy or transplantation but outcomes remain poor due to late stage at detection.

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    CHOLANGIOCARCINOMA

    Uploaded by

    PremaKurnia
    979 views26 pages
    Cholangiocarcinoma is a malignancy of the biliary tract that affects around 1 in 100,000 people annually in the US. It is more common in males over 50 and has a poor prognosis. Surgical resection offers the best chance of survival but many are unresectable at diagnosis. Risk factors include primary sclerosing cholangitis, viral hepatitis, parasites, gallstones, smoking and alcohol. Genetic mutations and chronic inflammation are believed to play a role in tumor development. Symptoms are often vague and diagnosis relies on imaging and tumor markers. Treatment involves surgery, radiation, chemotherapy or transplantation but outcomes remain poor due to late stage at detection.

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    CHOLANGIOCARCINOMA PPT

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    Cholangiocarcinoma is a malignancy of the biliary tract that affects around 1 in 100,000 people annually in the US. It is more common in males over 50 and has a poor prognosis. Surgical resection offers the best chance of survival but many are unresectable at diagnosis. Risk factors include primary sclerosing cholangitis, viral hepatitis, parasites, gallstones, smoking and alcohol. Genetic mutations and chronic inflammation are believed to play a role in tumor development. Symptoms are often vague and diagnosis relies on imaging and tumor markers. Treatment involves surgery, radiation, chemotherapy or transplantation but outcomes remain poor due to late stage at detection.

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    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    979 views26 pages

    CHOLANGIOCARCINOMA

    Uploaded by

    PremaKurnia
    Cholangiocarcinoma is a malignancy of the biliary tract that affects around 1 in 100,000 people annually in the US. It is more common in males over 50 and has a poor prognosis. Surgical resection offers the best chance of survival but many are unresectable at diagnosis. Risk factors include primary sclerosing cholangitis, viral hepatitis, parasites, gallstones, smoking and alcohol. Genetic mutations and chronic inflammation are believed to play a role in tumor development. Symptoms are often vague and diagnosis relies on imaging and tumor markers. Treatment involves surgery, radiation, chemotherapy or transplantation but outcomes remain poor due to late stage at detection.

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    CHOLANGIOCARCINOMA

    SGD B08
    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:

    GENETIC OR
    INFLAMMATION MOLECULAR
    THEORY THEORY
    INFLAMMATION THEORY

    Chronic
    Inflammator Nitrosative DNA Carcinogene
    Inflammatio iNOS active
    y Cytokines stress damage sis
    n
    INFLAMMATION THEORY
    Increase
    Activate
    IL-6 expression
    STAT3
    of MCL1
    CCA
    developme
    nt increase

    Increase
    Cell
    Proliferation
    CHOLESTASIS

    Tumor
    ERBB2
    Formation
    Bile Activate
    Acid EGFR Invasivenes
    HGF s and Tumor
    Metastasis
    GENETIC OR MOLECULAR THEORY
    CODON 12

    K-ras CODON 13

    MUTATION
    CODON 61
    OF p53

    TGF
    SMAD4 signalling
    network
    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

    Klatskin
    iCCA pCCA dCCA
    Tumors

    Imaging Imaging Imaging Imaging

    Bismuth-
    Tumor Tumor
    Corlette
    marker marker
    system

    Genetic Genetic
    marker 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


    good
    compliance
    changing toward
    attitude therapy

    enhancing
    knowledge
    about disease
    and risk factor
    PROGNOSIS
    Prognosis
    remains poor
    Intrahepatic cholangiocarcinoma Extrahepatic cholangiocarcinoma
    Stage 5-year relative Stage 5-year relative
    survival survival
    Localiz 15% Localiz 30%
    ed ed
    Region
    Source: 6% Society
    American Cancer Region 24%
    al al
    Factors that affecting patient survival have been impeded by:
    Distant 2% Distant 2%
    lack of disease-specific symptoms in early stages
    surgical resection not being an appropriate treatment option
    high rates of tumor recurrence following surgical resection

    od 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
    Chemotherapy or radiotherapy
    Treatment using chemotherapy or radiotherapy was found to prolong
    survival of ICC patients with unresectable tumors; ex. gemcitabine-based
    adjuvant
    Distal chemotherapy
    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 UmL)
    no relapse are associated
    less aggressive tumor conditions
    lower bilirubin levels
    highly differentiated tumor
    early stages of TNM staging
    no intraoperative blood transfusion
    Prognosis
    r 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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