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This is an introduction to the Gut tutorial “Cholangiocarcinoma and its management” hosted on BMJ Learning—the best available learning website for medical professionals from the BMJ Group.
Cholangiocarcinoma originates in the biliary epithelium. Mortality rates from intrahepatic cholangiocarcinoma appear to have risen steadily over the past 30 years and it now causes more deaths than hepatocellular carcinoma annually in England and Wales. Primary sclerosing cholangitis is the commonest known predisposing factor for cholangiocarcinoma in the UK. The commonest presenting clinical features of perihilar or extrahepatic tumours are those of biliary obstruction. CA 19–9 is elevated in up to 85% of patients with cholangiocarcinoma and has a sensitivity of 75% and specificity of 80% in patients with primary sclerosing cholangitis, but its value in patients without primary sclerosing cholangitis is limited. Good quality magnetic resonance imaging (MRI) is the optimal imaging investigation for suspected cholangiocarcinoma, providing accurate information on biliary anatomy and local invasion, extent of duct involvement with magnetic resonance cholangiopancreatography (MRCP) and vascular involvement by magnetic resonance angiography. Up to 50% of patients are lymph node positive at presentation, which is associated with poor surgical outcome. Perhaps 10–20% of patients have peritoneal involvement and laparoscopy could be considered to determine the presence of peritoneal or superficial liver metastases in those considered resectable on imaging. Surgery is the only curative treatment for patients with cholangiocarcinoma with a 9–18% five year survival for proximal bile duct lesions and 20–30% for distal lesions. Routine preoperative biliary drainage is no longer recommended if there is no undue delay prior to surgery, but in certain patients who are severely malnourished, or who are suffering from acute suppurative cholangitis, preoperative drainage is beneficial.
To access the tutorial (Interactive Case History), click on BMJ Learning: Take this module on BMJ Learning from the content box at the top right and bottom left of the online article. For more information please go to: http://gut.bmj.com/tutorials/collection.dtl
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Competing interests: None.