GASTROENTEROLOGY ARTICLE OF THE WEEK
September 1, 2005
Lazaridis K, Gores GJ. Cholangiocarcinoma. Gastroenterology 2005;128:1655-67
1. Cholangiocarcinoma (CCA) in patients with PSC
a. The risk is approximately 1.5%/yr after diagnosis of PSC
b. The risk rises with duration of PSC
c. Most CCA cases in PSC will be diagnosed in the first 2 years after PSC is
identified.
d. The incidence may be reduced by careful control of the associated IBD
2. Risk factors for CCA include
a. Alcoholic liver disease
b. Opisthorchis viverrini or Clonorchis sinensis infestation
c. Choledochal cysts
d. Intrahepatic cholelithiasis
e. Thorotrast exposure
f. Chronic hepatitis C infection
g. Exposure to vinyl chloride and dioxin
h. Gallstones
True or False
3. Most CCA’s in the US are extrahepatic, the majority are hilar and sclerosing type, resulting in annular thickening of the bile duct.
4. Cholangiocarcinoma can easily be identified histologically, it has a unique histologic appearance
5. Patients who are red blood cell Lewis phenotype negative will not express CA 19-9.
6. Jaundice, pruritus and malaise are typical prominent presenting symptoms of intrahepatic CCA
7. In CCA, cytology of bile duct lesions are often negative for malignancy due to the intense desmoplastic reaction of the tumor
8. In a PSC patient, sudden increase in AP, and serum CA 199 >100 in the absence of cholangitis is highly suspicious for CCA
9. A patient with CCA of the left hepatic branch, atrophied left lobe and normal sized right lobe likely has vascular encasement of the vasculature of the right lobe of the liver
10. Intrahepatic CCA may present as a single hepatic mass mimicking metastatic disease of unknown primary.
11. For patients with unresectable tumors, stenting of all or most strictures must be accomplished to achieve resolution of jaundice
12. CCA is considered a contraindication to transplantation in most centers