Cholangiocarcinoma is a malignant tumor that occurs in the extrahepatic bile ducts, including the hepatic hilum to the distal end of the common bile duct. Cholangiocarcinoma can be classified according to the tumor location into intrahepatic cholangiocarcinoma and extrahepatic cholangiocarcinoma. It is more common in males than females. Most patients are aged 40 years and older.
Causes of Cholangiocarcinoma
- Chronic cholangitis: Long-term chronic inflammation is the basis for the development of cholangiocarcinoma because diseases associated with cholangiocarcinoma cause chronic inflammation of the bile ducts.
- Bile duct or gallbladder stones: 20% – 57% of cholangiocarcinoma patients have bile duct or gallbladder stones. Therefore, chronic inflammation of the gallbladder and bile ducts is a factor that causes cancer.
- Abnormal bile duct (congenital bile duct dilation): Having a cyst in the bile duct from birth can easily lead to malignant transformation. When the pancreatic duct and bile duct flow are abnormal, pancreatic fluid refluxes into the bile duct, causing changes in the bile duct epithelium, which is a major cause of malignant transformation.
- Liver fluke disease (Chinese liver fluke): Eating raw fish can cause liver fluke disease and infection in the bile ducts, bile stasis, fibrosis around the bile ducts, and bile duct dilation, which are among the causes of cholangiocarcinoma.
Symptoms of Cholangiocarcinoma
- Jaundice and yellowing of the eyes caused by bile duct obstruction
- Abdominal pain: After eating, mild discomfort in the upper abdomen, epigastric pain, back pain, or right upper abdominal tenderness, which are symptoms of nerve involvement by the tumor
- Fever: Tumor obstruction of the bile duct can cause inflammation inside the bile duct, leading to fever, although this is relatively rare
- Itching all over the skin
- Other symptoms: Associated symptoms include loss of appetite, aversion to fatty foods, fatigue, weight loss, nausea, and vomiting
Methods for Diagnosing Cholangiocarcinoma
- Laboratory tests: To check for liver function abnormalities
- Ultrasound of the liver and upper abdomen
- CT scan or MRI (MRI + MRCP): Can show bile duct dilation, the location and extent of bile duct obstruction quite clearly, and accurately display anatomical changes of the bile ducts and tumors
- ERCP examination: Provides a comprehensive view of the bile ducts and allows direct collection of bile and cells released by cholangiocarcinoma
Treatment of Cholangiocarcinoma
Treatment of cholangiocarcinoma involves considering factors such as tumor size, location, cancer cell characteristics, disease stage, cancer spread, and the overall health of the patient to plan the best and most appropriate treatment for each individual. Treatment methods for cholangiocarcinoma include:
- Tumor resection surgery: This is the standard treatment that yields good results and increases patient survival rates
- Bile duct drainage surgery: For patients expected to undergo tumor resection but found during surgery that the disease stage is inoperable, bile duct drainage surgery should be performed to relieve itching and jaundice
- Endoscopic Retrograde Cholangiopancreatography (ERCP): Used when tumor resection is not possible or the patient cannot undergo surgery
- Chemotherapy/radiotherapy: Used when the tumor cannot be completely removed by surgery or as adjuvant therapy after surgery to increase the chance of cure
