Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- icterícia indolor
- perda de peso
- dor abdominal
Other diagnostic factors
- prurido
- tríade de febre, icterícia e dor no quadrante superior direito do abdome
- vesícula biliar palpável
- hepatomegalia
- urina escura
- fezes claras
- assintomático
Risk factors
- idade >50 anos
- colangite
- coledocolitíase
- colecistolitíase
- outros distúrbios estruturais do trato biliar
- colite ulcerativa
- colangite esclerosante primária
- cirrose inespecífica
- hepatopatia alcoólica
- infecção por parasitas hepáticos
- portador crônico de febre tifoide
- vírus da hepatite C (HCV)
- vírus da imunodeficiência humana (HIV)
- vírus da hepatite B (HBV)
- exposição ao dióxido de tório
- diabetes
- tabagismo
- exposição a toxinas/medicamentos
- sexo masculino
Diagnostic investigations
1st investigations to order
- bilirrubina sérica
- fosfatase alcalina sérica
- gama-glutamiltransferase sérica
- aminotransferase sérica
- tempo de protrombina sérica
- antígeno CA 19-9 sérico
- antígeno carcinoembriogênico (CEA) sérico
- antígeno CA-125 sérico
- ultrassonografia abdominal
- tomografia computadorizada (TC) abdominal
- ressonância nuclear magnética (RNM) abdominal
Investigations to consider
- ultrassonografia endoscópica (USE)
- angiografia por ressonância magnética (RM)
- colangiopancreatografia retrógrada endoscópica (CPRE)
- colangiopancreatografia por ressonância magnética (CPRM)
- cateterismo trans-hepático percutâneo (CTP)
- tomografia por emissão de pósitrons (PET)
- Imunocoloração
Emerging tests
- tomografia de coerência óptica (TCO)
- colangioscopia peroral
- colangioscopia assistida por duodenoscópio
Treatment algorithm
doença ressecável
doença irressecável
Contributors
Authors
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
Disclosures
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
Disclosures
PS declares that he has no competing interests.
Acknowledgements
We would like to acknowledge our Gastroenterology expert panel member, Dr Brooks Cash, for his contribution to this topic.
Disclosures
BC declares that he has no competing interests.
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.
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.
References
Key articles
Bridgewater J, Galle PR, Khan SA, et al. Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol. 2014;60:1268-1289.Full text Abstract
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.Full text Abstract
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.Full text Abstract
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: biliary tract cancers [internet publication].Full text
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.Full text Abstract
Reference articles
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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