Cholangiocarcinoma

Last reviewed: 30 May 2022
Last updated: 03 Feb 2022

Summary

Definition

History and exam

Key diagnostic factors

  • painless jaundice
  • weight loss
  • abdominal pain
More key diagnostic factors

Other diagnostic factors

  • pruritus
  • triad of fever, jaundice, and RUQ pain
  • palpable gallbladder
  • hepatomegaly
  • dark urine
  • pale stools
Other diagnostic factors

Risk factors

  • age >50 years
  • cholangitis
  • choledocholithiasis
  • cholecystolithiasis
  • other structural disorders of the biliary tract
  • ulcerative colitis (UC)
  • primary sclerosing cholangitis (PSC)
  • nonspecific cirrhosis
  • alcoholic liver disease
  • liver fluke infection
  • chronic typhoid carrier
  • hepatitis C virus (HCV)
  • HIV
  • hepatitis B virus (HBV)
  • exposure to thorium dioxide
  • diabetes
  • cigarette smoking
  • exposure to toxins/medications
  • male sex
More risk factors

Diagnostic investigations

1st investigations to order

  • serum bilirubin
  • serum alk phos
  • serum gamma-GT
  • serum aminotransferase
  • serum prothrombin time
  • serum CA 19-9
  • serum carcinoembryonic antigen (CEA)
  • serum CA 19-9 + (40 times CEA)
  • serum CA-125
  • abdominal ultrasound
More 1st investigations to order

Investigations to consider

  • abdominal CT
  • abdominal MRI
  • MR angiography
  • ERCP
  • MRCP
  • percutaneous transhepatic catheterization (PTC)
  • positron emission tomography (PET)
  • Immunostaining
More investigations to consider

Emerging tests

  • optical coherence tomography (OCT)
  • peroral cholangioscopy
  • duodenoscope-assisted cholangioscopy

Treatment algorithm

ACUTE

resectable disease

unresectable disease

Contributors

Authors

N. Joseph Espat, MD, MS, FACS

Chairman of Surgery

Professor and Chief Surgical Oncology

Director Cancer Center

Department of Surgery

Roger Williams Medical Center

Boston University School of Medicine

Providence

RI

Disclosures

NJE declares he has no competing interests.

Ponnandai Somasundar, MD, MPH, FACS

Associate Professor and Associate Chief

Surgical Oncology

Department of Surgery

Roger Williams Medical Center

Boston University School of Medicine

Providence

RI

Disclosures

PS is an advisory board member for RWMC, and a clinical board consultant for Medtronic HPB.

Peer reviewers

Kevin Watkins, MD

Assistant Professor

Department of Surgery

Health Science Center

SUNY

Stony Brook

NY

Disclosures

KW declares that he has no competing interests.

Savio Reddymasu, MD

GI Fellow

Department of Medicine

Center for Gastrointestinal Motility

Division of Gastroenterology and Hepatology

University of Kansas Medical Center

Kansas City

KS

Disclosures

SR declares that he has no competing interests.

Satvinder Mudan, MBBS, BSc, MD, FRCS

Consultant in Surgical Oncology

The Royal Marsden Hospital

London

UK

Disclosures

SM declares that he has no competing interests.

  • Cholangiocarcinoma images
  • Differentials

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    • Ampullary carcinoma
    • Pancreatic carcinoma
    More Differentials
  • Guidelines

    • NCCN clinical practice guidelines in oncology: hepatobiliary cancers
    • Adjuvant therapy for resected biliary tract cancer: ASCO clinical practice guideline
    More Guidelines
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