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Cholangiocarcinoma

最后审阅: 15 Sep 2025
最后更新: 27 Aug 2025

小结

定义

病史和体格检查

关键诊断因素

  • painless jaundice
  • weight loss
  • abdominal pain
完整详情

其他诊断因素

  • pruritus
  • triad of fever, jaundice, and right upper quadrant pain
  • palpable gallbladder
  • hepatomegaly
  • dark urine
  • pale stools
  • asymptomatic
完整详情

危险因素

  • 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
完整详情

诊断性检查

首要检查

  • serum bilirubin
  • serum alkaline phosphatase
  • serum gamma-GT
  • serum aminotransferase
  • serum prothrombin time
  • serum CA 19-9
  • serum carcinoembryonic antigen (CEA)
  • serum CA-125
  • abdominal ultrasound
  • abdominal CT
  • abdominal MRI
完整详情

需考虑的检查

  • endoscopic ultrasound (EUS)
  • MR angiography
  • ERCP
  • MRCP
  • percutaneous transhepatic catheterization (PTC)
  • positron emission tomography (PET)
  • Immunostaining
完整详情

新兴检查

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

治疗流程

急症处理

resectable disease

unresectable disease

撰稿人

作者

N. Joseph Espat, MD, MS, FACS

Chairman of Surgery

Professor

Director Cancer Center

Department of Surgery

Roger Williams Medical Center

Boston University School of Medicine

Providence

RI

利益声明

NJE declares he has no competing interests.

Ponnandai Somasundar, MD, MPH, FACS

Associate Professor and Chief of Surgical Oncology

Department of Surgery

Roger Williams Medical Center

Boston University School of Medicine

Providence

RI

利益声明

PS declares that he has no competing interests.

鸣谢

We would like to acknowledge our Gastroenterology expert panel member, Dr Brooks Cash, for his contribution to this topic.

利益声明

BC declares that he has no competing interests.

同行评议者

Kevin Watkins, MD

Assistant Professor

Department of Surgery

Health Science Center

SUNY

Stony Brook

NY

利益声明

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

利益声明

SR declares that he has no competing interests.

Satvinder Mudan, MBBS, BSc, MD, FRCS

Consultant in Surgical Oncology

The Royal Marsden Hospital

London

UK

利益声明

SM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Bridgewater J, Galle PR, Khan SA, et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol. 2014;60:1268-1289.全文  摘要

Bowlus CL, Arrivé L, Bergquist A, et al. AASLD practice guidance on primary sclerosing cholangitis and cholangiocarcinoma. Hepatology. 2023 Feb 1;77(2):659-702.全文  摘要

Rushbrook SM, Kendall TJ, Zen Y, et al. British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma. Gut. 2023 Dec 7;73(1):16-46.全文  摘要

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: biliary tract cancers [internet publication].全文

Shroff RT, Kennedy EB, Bachini M, et al. Adjuvant Therapy for Resected Biliary Tract Cancer: ASCO Clinical Practice Guideline. J Clin Oncol. 2019 Apr 20;37(12):1015-1027.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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