Biliary Tract Tumors
CONTEXT
Biliary tract cancers, or cholangiocarcinomas, are rare tumors originating from the cells of the bile ducts. They are classified based on their location into extrahepatic duct cancers (outside the liver), intrahepatic duct cancers (within the liver), gallbladder cancers, and ampulla of Vater cancers.
Extrahepatic biliary cancers include tumors arising in the common hepatic duct, the junction of the hepatic ducts, or the bile duct (or distal cholangiocarcinomas) and peri-hilar tumors (or Klatskin tumors).
When biliary tract cancer causes symptoms, it is usually due to obstruction of the bile duct. Key signs and symptoms include jaundice, itching, light-colored stools, dark urine, abdominal pain, loss of appetite, fever, nausea, and vomiting.
Diagnostic and staging tests for biliary tract cancer typically include ultrasound, endoscopic or laparoscopic ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), cholangiography (via resonance, endoscopic, or percutaneous approaches), positron emission tomography (PET), angiography, and laparoscopy.
PROCEDURE
Treatment is based on staging. When the disease is localized and resectable, surgery is the preferred treatment, as it is the only option with curative intent. Post-surgery, additional treatment may be offered to some patients following assessment by a multidisciplinary team. Depending on the case, this may include chemotherapy, concurrent chemotherapy and radiotherapy, re-surgery if there is gross residual disease, or simply observation.
For cases deemed unresectable (e.g., some stage III cases), options should be discussed, such as bile duct drainage (endoscopic with stent placement, percutaneous, or surgical), followed by complementary treatment. This could involve a research protocol (when available), concurrent chemotherapy and radiotherapy, isolated chemotherapy, or exclusive clinical support. If the patient has an excellent response to the chosen treatment, surgical intervention may be reconsidered.
In metastatic disease, treatment is palliative, with options limited to chemotherapy or exclusive clinical support.
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