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 above.
Causes of Cholangiocarcinoma
- Chronic cholangitis: Chronic inflammation over a long period is the basis for the development of cholangiocarcinoma because diseases that are detected and associated with cholangiocarcinoma cause chronic cholangitis.
- Bile duct or gallbladder stones: 20% – 57% of cholangiocarcinoma patients have stones in the bile duct or gallbladder. Therefore, chronic inflammation of the gallbladder and bile ducts is a factor causing cancer.
- Congenital bile duct abnormalities (congenital bile duct dilation): Having cysts in the bile duct from birth can easily lead to malignant cell changes. When the flow of the pancreatic duct and bile duct is abnormal, pancreatic fluid flows back into the bile duct, causing changes in the bile duct epithelium, which is a major cause of malignant transformation.
- Clonorchiasis (Chinese liver fluke): Eating raw fish can cause clonorchiasis 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, or colicky pain under the sternum, back pain, or pressure pain in the right upper abdomen, which are symptoms of nerve involvement by the tumor
- Fever: Tumor obstruction of the bile duct causes inflammation inside the bile duct, leading to fever, although the incidence is relatively low
- Itching all over the skin
- Other symptoms: Associated symptoms include loss of appetite, aversion to fatty foods, fatigue, weight loss, nausea, and vomiting
Diagnosis of Cholangiocarcinoma
- Laboratory tests: To check for liver function abnormalities
- Ultrasound of the liver and upper abdomen
- CT Scan or 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 duct and tumor characteristics
- ERCP: Provides a comprehensive view of the bile duct system and allows direct collection of bile and cells released by cholangiocarcinoma
Treatment of Cholangiocarcinoma
- Treatment of cholangiocarcinoma depends on factors such as tumor size, location, cancer cell characteristics, disease stage, cancer spread, and overall patient health to plan the best and most appropriate treatment for each patient. Treatment methods include:
- Tumor resection surgery: The standard treatment method that is effective and increases patient survival rates
- Bile duct drainage surgery: For patients expected to have tumor resection but found inoperable during surgery, 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 complete tumor removal is not possible or as adjuvant therapy after surgery to increase the chance of cure
