Materiały źródłowe

• #1 Diagnosis of Cholangiocarcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9858255/

  Cholangiocarcinoma (CCA), a tumor of the bile duct epithelium, is increasing in incidence. CCA remains a highly fatal malignancy because early diagnosis is difficult. Imaging modalities, including transabdominal ultrasound, computed tomography, and magnetic resonance imaging, play an important role in detecting tumors as well as guiding biopsy procedures and staging workups in CCA. Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are recommended as the next step in the evaluation of extrahepatic CCA. Tissue is obtained through EUS-FNA or ERCP (biopsy, brush cytology), and therapeutic intervention (such as stent insertion) is performed with ERCP. Moreover, several serum tumor markers (carbohydrate antigen 19-9 and carcinoembryonic antigen) can be useful in diagnosing CCA in some patients.

• #1 Bile Duct Cancer Diagnostic Tests | How Do You Test for Bile Duct Cancer? | American Cancer Society

  https://www.cancer.org/cancer/types/bile-duct-cancer/detection-diagnosis-staging/how-diagnosed.html

  Most bile duct cancers aren’t found until a person goes to a doctor because they have symptoms. […] If there’s reason to suspect you might have bile duct cancer, your doctor will want to take your complete medical history to check for risk factors and learn more about your symptoms. […] If bile duct cancer is suspected, the exam will focus mostly on your abdomen (belly) to check for any lumps, tenderness, or build-up of fluid. […] If your symptoms and/or the results of your physical exam suggest you might have bile duct cancer, tests will be done. These could include lab tests, imaging tests, and other procedures. […] Your blood might be sent to the lab to test your liver and gallbladder function or to test for certain tumor markers. […] Lab tests might be done to find out how much bilirubin is in your blood.

• #1 Cholangiocarcinoma (bile duct cancer) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cholangiocarcinoma/symptoms-causes/syc-20352408

  Cholangiocarcinoma is often diagnosed when it’s advanced, making successful treatment difficult to achieve. […] See your doctor if you have persistent fatigue, abdominal pain, jaundice, or other signs and symptoms that bother you. He or she may refer you to a specialist in digestive diseases (gastroenterologist). […] Cholangiocarcinoma happens when cells in the bile ducts develop changes in their DNA. A cell’s DNA contains the instructions that tell a cell what to do. The changes tell the cells to multiply out of control and form a mass of cells (tumor) that can invade and destroy healthy body tissue. It’s not clear what causes the changes that lead to cholangiocarcinoma. […] Factors that may increase your risk of cholangiocarcinoma include: […] Cholangiocarcinoma (bile duct cancer) care at Mayo Clinic.

• #1 Cholangiocarcinoma (Bile Duct Cancer)

  https://my.clevelandclinic.org/health/diseases/21524-cholangiocarcinoma

  Cholangiocarcinoma is a rare cancer that starts in your bile ducts. Bile ducts are thin tubes that bring bile (a fluid that helps you digest fats) from your liver and gallbladder to your small intestine. […] Most people receive a cholangiocarcinoma diagnosis after its already spread outside of their bile ducts. At this point, bile duct cancer is difficult to treat, and the prognosis (chance of recovery) is usually poor. […] Tests for cholangiocarcinoma may include: Liver function tests: These liver tests check your blood for high levels of substances, such as elevated liver enzymes, that might indicate your liver isnt working as it should. High levels may also mean you have a bile duct blockage. […] If test results indicate cancer, your healthcare provider will perform a biopsy to confirm the diagnosis. A biopsy removes a tissue sample so it can be tested for cancer.

• #1 Cholangiocarcinoma (bile duct cancer) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cholangiocarcinoma/diagnosis-treatment/drc-20352413

  Endoscopic retrograde cholangiopancreatography (ERCP) uses a dye to highlight the bile ducts on X-ray images. A thin, flexible tube with a camera on the end, called an endoscope, goes through the throat and into the small intestine. The dye enters the ducts through a small hollow tube, called a catheter, passed through the endoscope. Tiny tools passed through the catheter also can be used to remove gallstones. […] If your doctor suspects cholangiocarcinoma, he or she may have you undergo one or more of the following tests: […] Checking the level of carbohydrate antigen (CA) 19-9 in your blood may give your doctor additional clues about your diagnosis. CA 19-9 is a protein that’s overproduced by bile duct cancer cells. […] A test to examine your bile duct with a small camera. During endoscopic retrograde cholangiopancreatography (ERCP), a thin, flexible tube equipped with a tiny camera is passed down your throat and through your digestive tract to your small intestine. The camera is used to examine the area where your bile ducts connect to your small intestine. Your doctor may also use this procedure to inject dye into the bile ducts to help them show up better on imaging tests.

• #1 Diagnosis of Cholangiocarcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9858255/

  The key blood biomarkers for the diagnosis of CCA are carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA). However, its weakness as a diagnostic marker lies in the limited sensitivity for detecting early-stage CCA and the possibility that it could be raised in benign diseases. […] In the diagnosis of CCA, a blood CEA level greater than 5.2 ng/mL showed a sensitivity of 68% and a specificity of 82%. […] All patients with suspected CCA should be checked for tumor biomarkers (CA 19-9, CEA), and patients with intrahepatic tumors should additionally undergo an AFP check-up. Tumor biomarkers can be used not only for the diagnosis of CCA but also for treatment monitoring and determining recurrence.

• #1 Bile Duct Cancer Diagnostic Tests | How Do You Test for Bile Duct Cancer? | American Cancer Society

  https://www.cancer.org/cancer/types/bile-duct-cancer/detection-diagnosis-staging/how-diagnosed.html

  Some of these tests may be called liver function tests. They can help diagnose bile duct, gallbladder, or liver disease. […] If you have higher levels of these substances in your blood, it might mean you have a blockage in your bile duct. […] People with bile duct cancer may have high blood levels of the markers called CEA and CA 19-9. […] Imaging tests can often show a bile duct blockage. […] If you have (or might have) bile duct cancer, you could have one or more of these tests: […] This is often the first imaging test done in people who have symptoms such as jaundice or pain in the right upper part of their abdomen (belly). […] An MDCT scan uses x-rays to make detailed cross-sectional images of your body. It can be used to help diagnose bile duct cancer by showing tumors in the area.

• #1 Cholangiocarcinoma (bile duct cancer) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cholangiocarcinoma/diagnosis-treatment/drc-20352413

  Imaging tests can help your doctor see your internal organs and look for signs of cholangiocarcinoma. Techniques used to diagnose bile duct cancer include ultrasound, computerized tomography (CT) scans and magnetic resonance imaging (MRI) combined with magnetic resonance cholangiopancreatography (MRCP). MRCP is increasingly being used as a noninvasive alternative to ERCP. It offers 3D images without the need for a dye to enhance the images. […] A biopsy is a procedure to remove a small sample of tissue for examination under a microscope. […] If your doctor confirms a diagnosis of cholangiocarcinoma, he or she tries to determine the extent (stage) of the cancer. Often this involves additional imaging tests. Your cancer’s stage helps determine your prognosis and your treatment options.

• #1 British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma | Gut

  https://gut.bmj.com/content/73/1/16

  Contrast enhanced multiphasic CT of the chest, abdomen and pelvis to stage the primary tumour, including assessment of local vascular relationships, should be undertaken for all types of CCA. […] Contrast enhanced MRI and magnetic resonance cholangiopancreatography (MRCP) should be undertaken for perihilar and intrahepatic tumours to better delineate the extent of biliary involvement and identify any satellites/intrahepatic metastases. […] For tumours involving the more distal extrahepatic duct, MRI is unlikely to add any further information over and above CT. […] 18F-fluoro-deoxy-glucose positron emission tomography (18FDG-PET) CT for detection of nodal and distant metastatic disease is recommended as part of staging investigations. […] Ultrasound (US) or CT-guided biopsy of the primary intrahepatic tumour or metastatic lesions should be undertaken to acquire a pathological diagnosis following MDT discussion and consensus.

• #1 Tests for bile duct cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/bile-duct-cancer/getting-diagnosed/tests-bile-duct-cancer

  Doctors might use tumour markers to monitor how well your cancer treatment is working or check if the cancer has come back. Doctors usually check the CA19-9 tumour marker for bile duct cancer. Some people with bile duct cancer don’t have a raised CA19-9 level. So your doctor will use this result alongside your other tests to see if you are likely to have bile duct cancer. […] A biopsy means taking a sample of tissue and sending it to the laboratory so it can be looked at under a microscope. This is the only way to be certain whether a lump or growth in the bile duct is a cancer or not. […] If a biopsy shows you have bile duct cancer, then you usually have tests to find out more about the cancer. The tests you might have include: PET scan, PET-CT scan, genetic tests on the cancer cells. Scans help your doctor see how big the cancer is and if it has spread. This is called the stage of the cancer.

• #1 Diagnosis and treatment of biliary malignancies: biopsy, cytology, cholangioscopy and stenting

  https://www.oaepublish.com/articles/2574-1225.2021.12

  The role of direct cholangioscopy in the diagnostic algorithm for biliary cancers is still being investigated given the complexity, availability, procedural duration, costs, and complications. It is a valuable tool for the investigation of indeterminate biliary strictures with prior ERCPs inconclusive for malignancy when the clinical suspicion is high.

• #1 Cholangiocarcinoma – Wikipedia

  https://en.wikipedia.org/wiki/Cholangiocarcinoma

  Endoscopic retrograde cholangiopancreatography (ERCP), an endoscopic procedure performed by a gastroenterologist or specially trained surgeon, has been widely used for this purpose. […] Surgical exploration may be necessary to obtain a suitable biopsy and to accurately stage a person with cholangiocarcinoma. […] Histologically, cholangiocarcinomas are classically well to moderately differentiated adenocarcinomas. […] Immunohistochemistry is useful in the diagnosis and may be used to help differentiate a cholangiocarcinoma from hepatocellular carcinoma and metastasis of other gastrointestinal tumors.

• #1 Bile Duct Cancer (Cholangiocarcinoma) Diagnosis | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/bile-duct-cancer-cholangiocarcinoma/diagnosis

  In this procedure, a doctor inserts a laparoscope (a thin lighted tube with a camera on its tip) through a small incision (cut) in the abdominal wall to look at the organs in the belly or pelvis. […] Sometimes a bile duct tumor is too small to do a biopsy. If cancer is suspected, surgery to remove the tumor may be necessary to confirm the diagnosis.

• #1 Tests for bile duct cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/bile-duct-cancer/getting-diagnosed/tests-bile-duct-cancer

  PET scans show a 3 dimensional (3D) picture of the inside of your body. You might have a PET scan to help diagnose bile duct cancer, look for cancer in the lymph nodes and other parts of the body. […] A PET-CT scan combines a CT scan and a PET scan. You might have a PET-CT scan to look for cancer in the lymph nodes and other parts of your body. This helps your doctor find out the stage of your cancer. […] If a biopsy shows you have bile duct cancer, your doctor will usually look to see if the cancer cells have any gene changes (mutations). This can include mutations to the IDH1 gene, FGFR2 gene. Knowing this helps your doctors decide which treatment is best for you.

• #1 Diagnosis and treatment of biliary malignancies: biopsy, cytology, cholangioscopy and stenting

  https://www.oaepublish.com/articles/2574-1225.2021.12

  Bile duct brushings are commonly performed to differentiate benign from malignant strictures. Several studies have shown variable sensitivity rates from 23%-86%. Kurzawinski et al. in the prospective study of 100 patients with biliary strictures reported a 33% sensitivity for detection of CCA. A meta-analysis of more than 1500 patients by Burnett et al. reported a sensitivity of 42%. Frequently cytology is combined with fluorescent in situ hybridization (FISH) or mutation profiling (MP) to increase sensitivity. […] Endoluminal biopsy using biliary forceps is technically more challenging compared to brushings and generally requires a sphincterotomy. It can also be difficult to perform in narrow bile ducts and tumors higher up in the biliary tree and complications related to tumor bleeding and perforation should be kept in mind. Studies have shown varying sensitivity between 50% and 81% for the diagnosis of biliary cancers.

• #1 Recent Advancement in Diagnosis of Biliary Tract Cancer through Pathological and Molecular Classifications

  https://www.mdpi.com/2072-6694/16/9/1761

  However, as no specific radiological pattern exists, histopathological or cytological results are necessary to confirm the diagnosis. […] Preoperative cholangiography, which can be performed using either ERCP or PTC, may be necessary either for diagnostic or therapeutic purposes for patients with biliary obstruction. […] The utility of IDUS lies in its ability to characterize malignant biliary strictures and determine the local staging of cholangiocarcinoma. […] Liquid biopsy is a blood test that identifies circulating tumor cells, cell-free nucleic acids, and secreted proteins present in body fluids, such as blood, urine, saliva, and bile. […] Recently, various emerging analytical methods for extracellular vesicles (EVs), nucleic acids, proteins, and metabolites in bile have been developed as potential biomarkers for BTC diagnosis.

• #1 Recent Advancement in Diagnosis of Biliary Tract Cancer through Pathological and Molecular Classifications

  https://www.mdpi.com/2072-6694/16/9/1761

  Pathologic diagnosis for patients suspected of having BTC can be determined using a range of methods, including ERCP or PTC-guided biopsy, brush cytology, EUS-FNA, and ultrasonography/CT/MRI-guided biopsy. […] Molecular profiling is recommended for advanced diseases and is considered suitable for systemic treatments.

• #1 Clinical manifestations and diagnosis of cholangiocarcinoma – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-cholangiocarcinoma

  Clinical manifestations and diagnosis of cholangiocarcinoma […] The clinical manifestations and diagnosis of cholangiocarcinoma will be reviewed here. […] The most recent (2017) revision of the tumor, node, metastasis (TNM) classification no longer considers type IV tumors to represent a T4 primary tumor. […] Specific tests include serologic tests such as tumor markers (CA 19-9, CEA, combined CEA and CA 19-9, alpha-fetoprotein), imaging studies (ultrasound, MDCT, MRI and MRCP), endoscopy and percutaneous cholangiography, positron emission tomography scan, chest computed tomography, and angiography. […] Algorithms for the diagnosis of cholangiocarcinoma include approaches for patients with and without primary sclerosing cholangitis (PSC). […] Distal bile duct cancer TNM staging AJCC UICC 8th edition, perihilar bile duct cancer TNM staging AJCC UICC 8th edition, and intrahepatic bile duct cancer TNM staging AJCC UICC 8th edition are relevant classifications.

• #1 Cholangiocarcinoma | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/cholangiocarcinoma?lang=us

  Cholangiocarcinomas (commonest type of bile duct cancers) are malignant epithelial tumors arising from the biliary tree, excluding the gallbladder or ampulla of Vater. Cholangiocarcinoma is the third most common primary hepatobiliary malignancy after hepatocellular carcinoma (HCC) and gallbladder cancer. They tend to have a poor prognosis and high morbidity. […] The most important factor in prognosis is whether or not the tumor can be resected. Unfortunately, when discovered, most cases are too advanced for curative resection. Even with resection, the prognosis is poor, with a 5-year survival of only 10-44%, with the prognosis favoring extrahepatic tumors (around 30% 5-year survival vs 15% for intrahepatic tumors). […] Direct cholangiography is a blanket term for any imaging obtained with intra-biliary tree contrast and includes: PTC, ERCP, CT IVC, MRCP. All these modalities not only allow evaluation of the biliary tree but are invaluable in planning treatment and assessing for resectability.

• #1 Update on the Screening, Diagnosis, and Management of Cholangiocarcinoma – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/march-2024/update-on-the-screening-diagnosis-and-management-of-cholangiocarcinoma/

  Cholangiocarcinoma (CCA) is a neoplasm of the biliary tract that has become increasingly prevalent throughout the world. Lesions are typically identified via cross-sectional imaging and/or elevated serum carbohydrate antigen 19-9 levels, often followed by cytology or brushings with fluorescence in situ hybridization for confirmation. The goal of this article is to review current methods for screening and diagnosis of CCA, available treatments, and relevant recommendations by national and international medical societies. Symptoms of CCA are often absent or nonspecific, including jaundice, abdominal pain, decreased appetite, weight loss, and night sweats. Thus, the diagnosis of CCA usually stems from the identification of masses from imaging studies for other causes or symptomatic biliary strictures. Approximately 20% to 40% of patients with iCCA receive their diagnosis incidentally. There is no consensus regarding which individuals should undergo regular screening for CCA. However, current American Association for the Study of Liver Diseases (AASLD) guidelines recommend annual screening in patients with PSC to monitor for CCA and gallbladder carcinoma using magnetic resonance imaging (MRI) or magnetic resonance cholangiopancreatography, with or without serum biomarkers. Current American College of Gastroenterology guidelines recommend that patients suspected to have CCA on ultrasound screening should receive confirmatory MRI or CT scans. Imaging is also used in staging CCA spread beyond the liver and/or biliary tree, utilizing CT, MRI, or 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET), which can identify distant metastases. The AASLD and European Society for Medical Oncology recommend that patients with elevated CA19-9 levels undergo follow-up imaging for CCA. The AASLD specifically recommends using multiphasic CT or MRI to detect primary and potential secondary tumors and distant metastases and confirm imaging findings with biopsy for a definitive diagnosis. Although biopsy is the only way to obtain a definitive diagnosis of CCA, many providers avoid it owing to the risk of tumor seeding. The decision to utilize biopsy to diagnose CCA must carefully weigh the risks and benefits to the procedure. Society recommendations for the utilization of biopsy in CCA diagnosis therefore reflect the nuances in this decision-making process. In addition to histology, cytology can be used to positively identify CCA. Cytologic samples for CCA are most frequently obtained from biliary brush samples taken during ERCP. Traditional cytology has a sensitivity of 21% to 50% and a specificity of 98% to 100%, which increase to 35% to 89% and 91% to 100%, respectively, when FISH is added. The AASLD currently recommends that FISH be used during cytologic analysis of ERCP brushings to aid in the diagnosis of CCA, as traditional cytology may not yield accurate results.

• #1 Bile duct cancer symptoms: Stages, outlook, and more

  https://www.medicalnewstoday.com/articles/bile-duct-cancer-symptoms

  Bile duct cancer, also known as cholangiocarcinoma, is a rare form of cancer that affects the bile ducts. […] Bile duct cancer is difficult to catch early. This is partly because the bile ducts are hard to reach, buried deep within the abdomen. Doctors cannot feel for a lump or mass during a routine exam, nor can they see one on imaging scans. […] There are no reliable screening tests to detect bile duct cancer early. […] To diagnose bile duct cancer, a doctor will review both family and personal medical history. If they suspect cancer, they may order a number of tests, which may include one or more of the following: angiography, which is a type of x-ray; cholangiography, a test that looks for blocks in the bile duct; MRI scan; CT scan; biopsy; blood tests to look for tumor markers and check liver functioning; ultrasounds. […] It is difficult to detect bile duct cancer before it has spread enough to cause symptoms. There are no reliable screening tests to detect bile duct cancer early. […] Diagnosis typically involves the use of several tests, including MRI and CT scans.

• #1 Cholangiocarcinoma: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/365065-overview

  Cholangiocarcinomas (CCCs) are malignancies of the biliary duct system that may originate in the liver and extrahepatic bile ducts, which terminate at the ampulla of Vater. […] Diagnosis includes lab studies that show elevated levels of conjugated bilirubin, alkaline phosphatase, and gamma-glutamyltransferase (GGT). […] Imaging studies generally involve ultrasonography or computed tomography (CT) followed by some form of cholangiography. […] Endoscopic retrograde cholangiopancreatography (ERCP) demonstrates the site of obstruction, excludes ampullary pathology, and allows collection of specimens for histologic studies. […] EUS-guided fine-needle aspiration has a greater sensitivity for detecting malignancy than ERCP with brush cytology but has the potential for tumor seeding.

• #1 Diagnosis of cholangiocarcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2504383/

  Cholangiocarcinoma is suspected based on signs of biliary obstruction, abnormal liver function tests, elevated tumor markers (carbohydrate antigen 19-9 and carcinoembryonic antigen), and ultrasonography showing a bile stricture or a mass, especially in intrahepatic cholangiocarcinoma. […] Magnetic resonance imaging (MRI) or computed tomography (CT) is performed for the diagnosis and staging of cholangiocarcinomas. […] When the diagnosis of a biliary stenosis remains indeterminate at MRI or CT, endoscopic imaging (endoscopic or intraductal ultrasound, cholangioscopy, or optical coherence tomography) and tissue sampling should be carried out. […] The diagnosis of cholangiocarcinoma is particularly challenging in patients with primary sclerosing cholangitis. […] The value of tumor markers in the diagnosis of cholangiocarcinomas remains controversial.

• #1 Clinical Scenario: Diagnostic Strategies to Identify Biliary Tract Cancers

  https://www.onclive.com/view/clinical-scenario-diagnostic-strategies-to-identify-biliary-tract-cancers

  The important piece that Dr Koay was mentioning is that we do need to get some specialized imaging to get the proper staging. When patients have multiple procedures and stents before they see a surgeon, it makes it more complicated to do that portion. […] I want to remind us that when Dr Gerald Klatskin described this tumor at Yale University in New Haven, Connecticut, he said the way to get the diagnosis is through surgical resection. But the majority of these patients are not surgically operable, so this diagnosis is often clinical. We shouldnt waste time with multiple unneeded modalities. […] Its the totality of the information you have that helps you come to the diagnosis of an intrahepatic cholangiocarcinoma. These are typically tumors in which you have a little more access to tissue, core needle biopsies, and things like that. You have the ability to hopefully histologically get a diagnosis.

• #1 British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma | Gut

  https://gut.bmj.com/content/73/1/16

  These guidelines for the diagnosis and management of cholangiocarcinoma (CCA) were commissioned by the British Society of Gastroenterology liver section. […] The management of CCA should be undertaken at centres with expertise across all relevant specialties, including surgery, interventional radiology, endoscopy, hepatobiliary medicine, oncology and pathology. […] All patients with CCA discussed at multidisciplinary team (MDT) meetings should be classified as best as possible into either intrahepatic, perihilar or distal CCA. This should be clearly recorded in the MDT outcome discussion. […] The requirement to have tissue available for molecular profiling to inform treatment decisions should be considered when immunohistochemistry is planned on lesional biopsy material. […] A diagnosis of combined hepatocellular-CCA should be made on morphological pathological grounds only.

• #2 Diagnosis of cholangiocarcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2504383/

  Cholangiocarcinoma is suspected based on signs of biliary obstruction, abnormal liver function tests, elevated tumor markers (carbohydrate antigen 19-9 and carcinoembryonic antigen), and ultrasonography showing a bile stricture or a mass, especially in intrahepatic cholangiocarcinoma. […] Magnetic resonance imaging (MRI) or computed tomography (CT) is performed for the diagnosis and staging of cholangiocarcinomas. […] When the diagnosis of a biliary stenosis remains indeterminate at MRI or CT, endoscopic imaging (endoscopic or intraductal ultrasound, cholangioscopy, or optical coherence tomography) and tissue sampling should be carried out. […] The diagnosis of cholangiocarcinoma is particularly challenging in patients with primary sclerosing cholangitis. […] The value of tumor markers in the diagnosis of cholangiocarcinomas remains controversial.

• #2 Cholangiocarcinoma (bile duct cancer) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/cholangiocarcinoma/symptoms-causes/syc-20352408

  Cholangiocarcinoma is often diagnosed when it’s advanced, making successful treatment difficult to achieve. […] See your doctor if you have persistent fatigue, abdominal pain, jaundice, or other signs and symptoms that bother you. He or she may refer you to a specialist in digestive diseases (gastroenterologist). […] Cholangiocarcinoma happens when cells in the bile ducts develop changes in their DNA. A cell’s DNA contains the instructions that tell a cell what to do. The changes tell the cells to multiply out of control and form a mass of cells (tumor) that can invade and destroy healthy body tissue. It’s not clear what causes the changes that lead to cholangiocarcinoma. […] Factors that may increase your risk of cholangiocarcinoma include: […] Cholangiocarcinoma (bile duct cancer) care at Mayo Clinic.

• #2 Bile Duct Cancer: A Complex, Difficult-to-Treat Disease | Patient Care

  https://weillcornell.org/news/bile-duct-cancer-a-complex-difficult-to-treat-disease

  Bile duct cancer, also known as cholangiocarcinoma, is a type of cancer that occurs in the bile ducts […] Improved diagnostic methods and imaging technologies may also contribute to the increased number of patients diagnosed with bile duct cancer. […] The increasing frequency of cholangiocarcinoma highlights the importance of early diagnosis and effective treatment strategies, as well as the need for continued research into the causes and risk factors of the disease. […] There are currently no routine screening tests for cholangiocarcinoma. However, people with known risk factors, such as those with primary sclerosing cholangitis or liver cirrhosis, may benefit from regular monitoring with imaging tests to detect any bile duct abnormalities or early-stage cancer. […] That having been said, early detection and prompt treatment are critical for improving outcomes in patients with cholangiocarcinoma.

• #2 Bile Duct Cancer Diagnostic Tests | How Do You Test for Bile Duct Cancer? | American Cancer Society

  https://www.cancer.org/cancer/types/bile-duct-cancer/detection-diagnosis-staging/how-diagnosed.html

  Some of these tests may be called liver function tests. They can help diagnose bile duct, gallbladder, or liver disease. […] If you have higher levels of these substances in your blood, it might mean you have a blockage in your bile duct. […] People with bile duct cancer may have high blood levels of the markers called CEA and CA 19-9. […] Imaging tests can often show a bile duct blockage. […] If you have (or might have) bile duct cancer, you could have one or more of these tests: […] This is often the first imaging test done in people who have symptoms such as jaundice or pain in the right upper part of their abdomen (belly). […] An MDCT scan uses x-rays to make detailed cross-sectional images of your body. It can be used to help diagnose bile duct cancer by showing tumors in the area.

• #2 Diagnosis of Cholangiocarcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9858255/

  The key blood biomarkers for the diagnosis of CCA are carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA). However, its weakness as a diagnostic marker lies in the limited sensitivity for detecting early-stage CCA and the possibility that it could be raised in benign diseases. […] In the diagnosis of CCA, a blood CEA level greater than 5.2 ng/mL showed a sensitivity of 68% and a specificity of 82%. […] All patients with suspected CCA should be checked for tumor biomarkers (CA 19-9, CEA), and patients with intrahepatic tumors should additionally undergo an AFP check-up. Tumor biomarkers can be used not only for the diagnosis of CCA but also for treatment monitoring and determining recurrence.

• #2 Tests for bile duct cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/bile-duct-cancer/getting-diagnosed/tests-bile-duct-cancer

  Doctors might use tumour markers to monitor how well your cancer treatment is working or check if the cancer has come back. Doctors usually check the CA19-9 tumour marker for bile duct cancer. Some people with bile duct cancer don’t have a raised CA19-9 level. So your doctor will use this result alongside your other tests to see if you are likely to have bile duct cancer. […] A biopsy means taking a sample of tissue and sending it to the laboratory so it can be looked at under a microscope. This is the only way to be certain whether a lump or growth in the bile duct is a cancer or not. […] If a biopsy shows you have bile duct cancer, then you usually have tests to find out more about the cancer. The tests you might have include: PET scan, PET-CT scan, genetic tests on the cancer cells. Scans help your doctor see how big the cancer is and if it has spread. This is called the stage of the cancer.

• #2 Tests for bile duct cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/bile-duct-cancer/getting-diagnosed/tests-bile-duct-cancer

  Ultrasound scans use high frequency sound waves to create a picture of a part of the body. You usually have an ultrasound scan of your abdomen. This helps doctors look at your bile ducts, pancreas, liver. […] A CT scan uses x-rays and a computer to create detailed pictures of the inside of your body. You usually have a CT scan of your chest and abdomen to look for any abnormal areas in your bile ducts and liver, any abnormal areas elsewhere in your abdomen and chest. […] You might have a regular MRI scan. You might also have a special type of MRI scan called an MRCP. MRI stands for magnetic resonance imaging. It is a type of scan that creates pictures using magnetism and radio waves. MRCP stands for magnetic resonance cholangio pancreatography. This type of MRI shows your pancreas, gallbladder and bile ducts in detail.

• #2 British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma | Gut

  https://gut.bmj.com/content/73/1/16

  Contrast enhanced multiphasic CT of the chest, abdomen and pelvis to stage the primary tumour, including assessment of local vascular relationships, should be undertaken for all types of CCA. […] Contrast enhanced MRI and magnetic resonance cholangiopancreatography (MRCP) should be undertaken for perihilar and intrahepatic tumours to better delineate the extent of biliary involvement and identify any satellites/intrahepatic metastases. […] For tumours involving the more distal extrahepatic duct, MRI is unlikely to add any further information over and above CT. […] 18F-fluoro-deoxy-glucose positron emission tomography (18FDG-PET) CT for detection of nodal and distant metastatic disease is recommended as part of staging investigations. […] Ultrasound (US) or CT-guided biopsy of the primary intrahepatic tumour or metastatic lesions should be undertaken to acquire a pathological diagnosis following MDT discussion and consensus.

• #2 Diagnosis of cholangiocarcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2504383/

  In unexplained biliary disease, CA 19-9 levels 100 UI/ml are considered suspicious for cholangiocarcinoma in the absence of an inflammatory process. […] The sensitivity of fluorodeoxyglucose positron emission tomography is limited in small, infiltrative, and mucinous cholangiocarcinomas. […] The diagnosis of cholangiocarcinoma remains difficult, despite the multiple diagnostic methods available.

• #2 Diagnosis and treatment of biliary malignancies: biopsy, cytology, cholangioscopy and stenting

  https://www.oaepublish.com/articles/2574-1225.2021.12

  ERCP is still considered the gold standard for biliary imaging with the ability to obtain tissue sampling for diagnosis. Due to recent advances in imaging modalities with CT and MRI/ MRCP, studies have shown comparable diagnostic accuracy with ERCP. ERCP is useful in the diagnosis of ECCA and peri-hilar CCA. Cholangiograms reveal a stricture in the biliary tract with or without upstream biliary ductal dilatation. Malignant strictures usually appear as long segments with irregularity and asymmetry with shelving. Histopathological diagnosis could be obtained with ERCP with one of the three modalities: (1) brush cytology; (2) aspiration of biliary fluid; and (3) biopsy with endobiliary forceps. The sensitivity of these techniques varies when performed individually versus in combination and carries a specificity of almost 100%.

• #2 Diagnosis of Cholangiocarcinoma

  https://www.mdpi.com/2075-4418/13/2/233

  The key blood biomarkers for the diagnosis of CCA are carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA). […] In the diagnosis of CCA, a blood CEA level greater than 5.2 ng/mL showed a sensitivity of 68% and a specificity of 82%. […] EUS can assess the regional lymph node status and the local extent of extrahepatic CCA. […] EUS-guided FNA can be performed to acquire tissue samples from tumors and enlarged lymph nodes. […] Brush cytology or biopsy of the suspicious lesion is conducted through ERCP or PTC. In a meta-analysis of 1,123 patients with CCA, the diagnostic sensitivity was 56% with brushing, 67% with biopsy, and 70.7% with brushing and biopsy combined.

• #2

  https://www.karmanos.org/karmanos/bile-duct-cancer-treated-at-karmanos

• #2 Recent Advancement in Diagnosis of Biliary Tract Cancer through Pathological and Molecular Classifications

  https://www.mdpi.com/2072-6694/16/9/1761

  However, as no specific radiological pattern exists, histopathological or cytological results are necessary to confirm the diagnosis. […] Preoperative cholangiography, which can be performed using either ERCP or PTC, may be necessary either for diagnostic or therapeutic purposes for patients with biliary obstruction. […] The utility of IDUS lies in its ability to characterize malignant biliary strictures and determine the local staging of cholangiocarcinoma. […] Liquid biopsy is a blood test that identifies circulating tumor cells, cell-free nucleic acids, and secreted proteins present in body fluids, such as blood, urine, saliva, and bile. […] Recently, various emerging analytical methods for extracellular vesicles (EVs), nucleic acids, proteins, and metabolites in bile have been developed as potential biomarkers for BTC diagnosis.

• #2 Bile Duct Cancer Diagnostic Tests | How Do You Test for Bile Duct Cancer? | American Cancer Society

  https://www.cancer.org/cancer/types/bile-duct-cancer/detection-diagnosis-staging/how-diagnosed.html

  MRI scans can provide a great amount of detail and be very helpful in looking at the bile ducts and other organs. […] A cholangiogram is an imaging test that looks at the bile ducts to see if they’re blocked, narrowed, or dilated (widened). […] If ERCP or PTC is being done, a sample of bile may be collected during the procedure to look for cancer cells in the fluid. […] Imaging tests might suggest that a bile duct cancer is present, but in many cases, samples of bile duct cells or tissue are removed (biopsied) and looked at with a microscope to be sure of the diagnosis. […] There are many ways to take biopsy samples to diagnose bile duct cancer. […] For example, cancer cells in biopsy samples (or surgery samples) might be tested for certain gene or protein changes (sometimes called genotyping or molecular profiling).

• #2 Diagnosis and treatment of biliary malignancies: biopsy, cytology, cholangioscopy and stenting

  https://www.oaepublish.com/articles/2574-1225.2021.12

  Bile duct brushings are commonly performed to differentiate benign from malignant strictures. Several studies have shown variable sensitivity rates from 23%-86%. Kurzawinski et al. in the prospective study of 100 patients with biliary strictures reported a 33% sensitivity for detection of CCA. A meta-analysis of more than 1500 patients by Burnett et al. reported a sensitivity of 42%. Frequently cytology is combined with fluorescent in situ hybridization (FISH) or mutation profiling (MP) to increase sensitivity. […] Endoluminal biopsy using biliary forceps is technically more challenging compared to brushings and generally requires a sphincterotomy. It can also be difficult to perform in narrow bile ducts and tumors higher up in the biliary tree and complications related to tumor bleeding and perforation should be kept in mind. Studies have shown varying sensitivity between 50% and 81% for the diagnosis of biliary cancers.

• #2 Bile Duct Cancer (Cholangiocarcinoma) Diagnosis | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/bile-duct-cancer-cholangiocarcinoma/diagnosis

  In this procedure, a doctor inserts a laparoscope (a thin lighted tube with a camera on its tip) through a small incision (cut) in the abdominal wall to look at the organs in the belly or pelvis. […] Sometimes a bile duct tumor is too small to do a biopsy. If cancer is suspected, surgery to remove the tumor may be necessary to confirm the diagnosis.

• #2 Recent Advancement in Diagnosis of Biliary Tract Cancer through Pathological and Molecular Classifications

  https://www.mdpi.com/2072-6694/16/9/1761

  Pathologic diagnosis for patients suspected of having BTC can be determined using a range of methods, including ERCP or PTC-guided biopsy, brush cytology, EUS-FNA, and ultrasonography/CT/MRI-guided biopsy. […] Molecular profiling is recommended for advanced diseases and is considered suitable for systemic treatments.

• #2 Update on the Screening, Diagnosis, and Management of Cholangiocarcinoma – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/march-2024/update-on-the-screening-diagnosis-and-management-of-cholangiocarcinoma/

  Cholangiocarcinoma (CCA) is a neoplasm of the biliary tract that has become increasingly prevalent throughout the world. Lesions are typically identified via cross-sectional imaging and/or elevated serum carbohydrate antigen 19-9 levels, often followed by cytology or brushings with fluorescence in situ hybridization for confirmation. The goal of this article is to review current methods for screening and diagnosis of CCA, available treatments, and relevant recommendations by national and international medical societies. Symptoms of CCA are often absent or nonspecific, including jaundice, abdominal pain, decreased appetite, weight loss, and night sweats. Thus, the diagnosis of CCA usually stems from the identification of masses from imaging studies for other causes or symptomatic biliary strictures. Approximately 20% to 40% of patients with iCCA receive their diagnosis incidentally. There is no consensus regarding which individuals should undergo regular screening for CCA. However, current American Association for the Study of Liver Diseases (AASLD) guidelines recommend annual screening in patients with PSC to monitor for CCA and gallbladder carcinoma using magnetic resonance imaging (MRI) or magnetic resonance cholangiopancreatography, with or without serum biomarkers. Current American College of Gastroenterology guidelines recommend that patients suspected to have CCA on ultrasound screening should receive confirmatory MRI or CT scans. Imaging is also used in staging CCA spread beyond the liver and/or biliary tree, utilizing CT, MRI, or 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET), which can identify distant metastases. The AASLD and European Society for Medical Oncology recommend that patients with elevated CA19-9 levels undergo follow-up imaging for CCA. The AASLD specifically recommends using multiphasic CT or MRI to detect primary and potential secondary tumors and distant metastases and confirm imaging findings with biopsy for a definitive diagnosis. Although biopsy is the only way to obtain a definitive diagnosis of CCA, many providers avoid it owing to the risk of tumor seeding. The decision to utilize biopsy to diagnose CCA must carefully weigh the risks and benefits to the procedure. Society recommendations for the utilization of biopsy in CCA diagnosis therefore reflect the nuances in this decision-making process. In addition to histology, cytology can be used to positively identify CCA. Cytologic samples for CCA are most frequently obtained from biliary brush samples taken during ERCP. Traditional cytology has a sensitivity of 21% to 50% and a specificity of 98% to 100%, which increase to 35% to 89% and 91% to 100%, respectively, when FISH is added. The AASLD currently recommends that FISH be used during cytologic analysis of ERCP brushings to aid in the diagnosis of CCA, as traditional cytology may not yield accurate results.

• #2 Newly Diagnosed & Connected | Cholangiocarcinoma Foundation

  https://www.cholangiocarcinoma.org/newly-diagnosed/

  Receiving a cholangiocarcinoma (bile duct cancer) diagnosis can be overwhelming. […] These next steps should help those with CCA and their loved ones find answers, support and hope during the first few weeks, months or years after diagnosis. […] If you have been diagnosed with cholangiocarcinoma, the single most important thing you can do is to see an oncologist and surgeon who specialize in your specific type of cancer; this may require a second opinion. […] Ask your doctor about biomarker testing (molecular profiling). Biomarker testing scans the DNA of your cancer cells for cancer-causing genetic mutations and other molecular abnormalities. This information can be used to match some patients to the most effective treatment available, whether it’s an existing drug or one under study in a clinical trial.

• #2 Hilar cholangiocarcinoma: diagnosis, treatment options, and management – Soares – Hepatobiliary Surgery and Nutrition

  https://hbsn.amegroups.org/article/view/3374/html

  The combination of MRI with MRCP is about 80% accurate in predicting HC resectability. […] Both ERCP and PTC have similar sensitivity (75-85%) and specificity (70-75%) with regard to their ability to attain a tissue diagnosis; however, it is important to note that a negative biopsy cannot be considered definitive and an underlying HC should always be suspected in the right clinical setting regardless of the biopsy results. […] MRCP has demonstrated similar efficacies to PTC and ERCP in identifying anatomic extension of tumors. […] The American Joint Committee on Cancer (AJCC) is the most commonly used staging system for CC. […] Margin negative (R0) resection remains the only treatment that offers the chance at long-term survival. […] In general, 5-year survival after surgical resection of HC ranges from 10% to 40%.

• #2 Clinical Scenario: Diagnostic Strategies to Identify Biliary Tract Cancers

  https://www.onclive.com/view/clinical-scenario-diagnostic-strategies-to-identify-biliary-tract-cancers

  Yes, I think so. I think those of us who see a lot of this feel pretty comfortable putting together pathology and radiology and clinical presentation to be able to come to that diagnosis. I agree with you. The honest truth is the time lags that happen waiting for an endoscopy and a colonoscopy and all of that just delay the care for these patients. Trying to be expeditious and looking at the sum of all the parts is really important.

• #2 British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma | Gut

  https://gut.bmj.com/content/73/1/16

  All centres managing patients with CCA should have clear established diagnostic pathways for patients presenting with jaundice/biliary obstruction, with streamlined transition to local and regional hepato-pancreato-biliary (HPB) MDT meetings. […] Having completed imaging, all patients should undergo a detailed review of clinical presentation, examination findings, blood investigations and imaging, ideally at a regionally coordinated hepatobiliary MDT meeting, with prompt assessment of the results and communication with the patient. […] Consideration should be given to possible benign causes of biliary tract stricturing/obstruction during MDT discussion, in correlation with appropriate serological investigations and clinical history, to ensure that alternative diagnoses are considered while a pathological diagnosis of CCA is secured.

• #3 Cholangiocarcinoma (Bile Duct Cancer)

  https://my.clevelandclinic.org/health/diseases/21524-cholangiocarcinoma

  Cholangiocarcinoma is a rare cancer that starts in your bile ducts. Bile ducts are thin tubes that bring bile (a fluid that helps you digest fats) from your liver and gallbladder to your small intestine. […] Most people receive a cholangiocarcinoma diagnosis after its already spread outside of their bile ducts. At this point, bile duct cancer is difficult to treat, and the prognosis (chance of recovery) is usually poor. […] Tests for cholangiocarcinoma may include: Liver function tests: These liver tests check your blood for high levels of substances, such as elevated liver enzymes, that might indicate your liver isnt working as it should. High levels may also mean you have a bile duct blockage. […] If test results indicate cancer, your healthcare provider will perform a biopsy to confirm the diagnosis. A biopsy removes a tissue sample so it can be tested for cancer.

• #3 Tests for bile duct cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/bile-duct-cancer/getting-diagnosed/tests-bile-duct-cancer

  Bile duct cancer is also called cholangiocarcinoma. It is a rare type of cancer that develops in the bile ducts. You usually have a number of tests to check for bile duct cancer. These include: blood tests, scans such as ultrasound scans and CT scans. Most people are diagnosed with bile duct cancer after they become unwell and go to AE. Others start by seeing their GP if they have symptoms that could be due to cancer. Some people are also diagnosed after having tests for something else. […] The tests you have first depend on the symptoms you have. Tests might include: physical examination, blood tests, ultrasound scan, CT scan, MRI scan, checking for tumour markers, taking a sample of tissue – this is called a biopsy. […] Blood tests can check your general health. This includes checking how well your liver and kidneys are working, the number of blood cells such as red blood cells.

• #3 Cholangiocarcinoma: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/365065-overview

  Cholangiocarcinomas (CCCs) are malignancies of the biliary duct system that may originate in the liver and extrahepatic bile ducts, which terminate at the ampulla of Vater. […] Diagnosis includes lab studies that show elevated levels of conjugated bilirubin, alkaline phosphatase, and gamma-glutamyltransferase (GGT). […] Imaging studies generally involve ultrasonography or computed tomography (CT) followed by some form of cholangiography. […] Endoscopic retrograde cholangiopancreatography (ERCP) demonstrates the site of obstruction, excludes ampullary pathology, and allows collection of specimens for histologic studies. […] EUS-guided fine-needle aspiration has a greater sensitivity for detecting malignancy than ERCP with brush cytology but has the potential for tumor seeding.

• #3 Bile Duct Cancer Diagnosis – NCI

  https://www.cancer.gov/types/liver/bile-duct-cancer/diagnosis

  Procedures that make pictures of the bile ducts and the nearby area help diagnose bile duct cancer (cholangiocarcinoma) and show how far the cancer has spread. […] Tests and procedures to detect, diagnose, and stage bile duct cancer are usually done at the same time. […] The following tests and procedures may be used: […] Carcinoembryonic antigen (CEA) and CA 19-9 tumor marker test: Tumor markers are released into the blood by organs, tissues, or tumor cells in the body. Increased levels of CEA and CA 19-9 may be a sign of bile duct cancer. […] Different procedures may be used to obtain a sample of tissue and diagnose bile duct cancer. […] A sample of tissue is removed and checked for signs of cancer. […] This procedure may be used when a person cannot have surgery. […] A sample of tissue is removed and checked for signs of cancer. […] This procedure may be used when a person cannot have surgery.

• #3 Cholangiocarcinoma – Wikipedia

  https://en.wikipedia.org/wiki/Cholangiocarcinoma

  Cholangiocarcinoma, also known as bile duct cancer, is a type of cancer that forms in the bile ducts. […] The diagnosis is suspected based on a combination of blood tests, medical imaging, endoscopy, and sometimes surgical exploration. […] The disease is confirmed by examination of cells from the tumor under a microscope. […] There are no specific blood tests that can diagnose cholangiocarcinoma by themselves. […] Serum levels of carcinoembryonic antigen (CEA) and CA19-9 are often elevated, but are not sensitive or specific enough to be used as a general screening tool. […] Ultrasound of the liver and biliary tree is often used as the initial imaging modality in people with suspected obstructive jaundice. […] While abdominal imaging can be useful in the diagnosis of cholangiocarcinoma, direct imaging of the bile ducts is often necessary.

• #3 Bile Duct Cancer (Cholangiocarcinoma) Diagnosis | MD Anderson Cancer Center

  https://www.mdanderson.org/cancer-types/bile-duct-cancer/bile-duct-cancer-diagnosis.html

  Biopsy: A small tissue sample is surgically removed and examined under a microscope for the presence of cancer cells. […] Imaging tests: Your doctor may use imaging tests to see any abnormalities and determine whether and how far the cancer has spread. Tests may include: […] CT or CAT (computed axial tomography) scan: An x-ray takes pictures from different angles. This provides a highly detailed image of your body. […] MRI (magnetic resonance imaging): Magnetic fields and radio waves create a detailed image of your organs. […] Magnetic resonance cholangiopancreatography (MRCP): This procedure is a non-invasive alternative to ERCP. It creates a 3D image of your bile ducts without using dye. […] Abdominal ultrasound: A special instrument bounces high-energy sound waves off your internal organs. The resulting echo patterns create a picture on a screen. An ultrasound may be used to determine if your cancer has spread to surrounding tissue.

• #3 Tests for bile duct cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/bile-duct-cancer/getting-diagnosed/tests-bile-duct-cancer

  Ultrasound scans use high frequency sound waves to create a picture of a part of the body. You usually have an ultrasound scan of your abdomen. This helps doctors look at your bile ducts, pancreas, liver. […] A CT scan uses x-rays and a computer to create detailed pictures of the inside of your body. You usually have a CT scan of your chest and abdomen to look for any abnormal areas in your bile ducts and liver, any abnormal areas elsewhere in your abdomen and chest. […] You might have a regular MRI scan. You might also have a special type of MRI scan called an MRCP. MRI stands for magnetic resonance imaging. It is a type of scan that creates pictures using magnetism and radio waves. MRCP stands for magnetic resonance cholangio pancreatography. This type of MRI shows your pancreas, gallbladder and bile ducts in detail.

• #3 Multimodal molecular imaging evaluation for early diagnosis and prognosis of cholangiocarcinoma | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-021-01147-7

  Molecular imaging is an emerging discipline at the intersection of molecular biology and traditional medical imaging. […] Compared with traditional imaging techniques, molecular imaging can detect the specific histopathological changes at the cellular and molecular levels before the morphological changes of the disease take place. […] This technology has the advantage of finding smaller lesions while simultaneously providing a basis for differential diagnosis and curative effect evaluation. […] In the near future, it is expected that molecular imaging techniques will be used to study the pathogenesis of CCA in more detail to identify the key components of the onset stage, thereby providing an early and definitive diagnosis of CCA. […] The sensitivity of 18F-FDG-PET in primary CCA is 90% or higher.

• #3 Diagnosis and treatment of biliary malignancies: biopsy, cytology, cholangioscopy and stenting

  https://www.oaepublish.com/articles/2574-1225.2021.12

  Bile duct brushings are commonly performed to differentiate benign from malignant strictures. Several studies have shown variable sensitivity rates from 23%-86%. Kurzawinski et al. in the prospective study of 100 patients with biliary strictures reported a 33% sensitivity for detection of CCA. A meta-analysis of more than 1500 patients by Burnett et al. reported a sensitivity of 42%. Frequently cytology is combined with fluorescent in situ hybridization (FISH) or mutation profiling (MP) to increase sensitivity. […] Endoluminal biopsy using biliary forceps is technically more challenging compared to brushings and generally requires a sphincterotomy. It can also be difficult to perform in narrow bile ducts and tumors higher up in the biliary tree and complications related to tumor bleeding and perforation should be kept in mind. Studies have shown varying sensitivity between 50% and 81% for the diagnosis of biliary cancers.

• #3 Diagnosis and treatment of biliary malignancies: biopsy, cytology, cholangioscopy and stenting

  https://www.oaepublish.com/articles/2574-1225.2021.12

  Biliary tract malignancies include cancers of the intra-hepatic and extra-hepatic bile ducts. Cholangiocarcinoma is the predominant biliary tract malignancy with nearly 60% of them occurring in the peri-hilar region. They can present with biliary strictures causing jaundice but can be insidious and present late in their clinical course. Recent advances in imaging and other diagnostic modalities help in the earlier identification of these tumors. Diagnosis should be suspected in anyone presenting with jaundice with evidence of biliary ductal dilatation or in patients with primary sclerosing cholangitis with worsening clinical status. The diagnostic approach consists of obtaining tumor markers, mainly CA 19-9, imaging modalities which include computed tomography and/or magnetic resonance imaging to establish the level of biliary obstruction and presence or absence of mass. Tissue sampling is performed with endoscopic retrograde cholangiopancreatography (ERCP) guided cytology and biopsies and with endoscopic ultrasound (EUS) if a mass is visible on imaging. Indeterminate strictures after initial biopsies could be further evaluated by cholangioscopy directed biopsies.

• #3 Diagnosis and treatment of biliary malignancies: biopsy, cytology, cholangioscopy and stenting

  https://www.oaepublish.com/articles/2574-1225.2021.12

  ERCP is still considered the gold standard for biliary imaging with the ability to obtain tissue sampling for diagnosis. Due to recent advances in imaging modalities with CT and MRI/ MRCP, studies have shown comparable diagnostic accuracy with ERCP. ERCP is useful in the diagnosis of ECCA and peri-hilar CCA. Cholangiograms reveal a stricture in the biliary tract with or without upstream biliary ductal dilatation. Malignant strictures usually appear as long segments with irregularity and asymmetry with shelving. Histopathological diagnosis could be obtained with ERCP with one of the three modalities: (1) brush cytology; (2) aspiration of biliary fluid; and (3) biopsy with endobiliary forceps. The sensitivity of these techniques varies when performed individually versus in combination and carries a specificity of almost 100%.

• #3 Diagnosis of Cholangiocarcinoma

  https://www.mdpi.com/2075-4418/13/2/233

  The key blood biomarkers for the diagnosis of CCA are carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA). […] In the diagnosis of CCA, a blood CEA level greater than 5.2 ng/mL showed a sensitivity of 68% and a specificity of 82%. […] EUS can assess the regional lymph node status and the local extent of extrahepatic CCA. […] EUS-guided FNA can be performed to acquire tissue samples from tumors and enlarged lymph nodes. […] Brush cytology or biopsy of the suspicious lesion is conducted through ERCP or PTC. In a meta-analysis of 1,123 patients with CCA, the diagnostic sensitivity was 56% with brushing, 67% with biopsy, and 70.7% with brushing and biopsy combined.

• #3 Bile Duct Cancer | Causes, Symptoms, Treatment & Support | Guts UK

  https://gutscharity.org.uk/advice-and-information/conditions/bile-duct-cancer/

  PSC is an autoimmune disease of the bile ducts. It is the most common known cause of cholangiocarcinoma. […] Symptoms can initially be vague and may include: Unintentional weight loss, Loss of appetite, Feeling tired or generally ‘unwell.’ […] Depending on the site of development of the bile duct cancer it may produce jaundice. […] A GP may do several blood tests on the liver. The tests are called liver function tests (LFT). They can find problems with the liver or bile ducts. […] The specialist will request further tests. The tests might include: Ultrasound scan, CT scan, MRI, MRCP, ERCP, EUS, PTC, PET. […] Imaging tests may strongly suggest cancer but the only way to confirm it is by taking a small cell sample (biopsy). […] Staging shows if the cancer has spread to nearby organs or to other areas in the body. Staging helps guide tissue sample collection and treatment options.

• #3 Get Bile Duct Cancer Treatment | Cleveland Clinic

  https://my.clevelandclinic.org/services/bile-duct-cancer-treatment

  Cancer treatment relies on the experience and input of providers from many different specialties. At Cleveland Clinic, your team of experts will work together to make sure you get the most personalized treatment and always keep you at the center of your care. […] No two cancers are the same. That’s why we tailor your treatment to match your needs. Your care plan is based on where the cancer is, if it’s spread (stage) and your overall health. […] Depending on your test results, we may recommend a variety of treatment options. […] For early-stage bile duct cancer (cholangiocarcinoma), we can often remove part of your bile duct or we may take part of your bile duct and a section of your liver (partial hepatectomy). […] If cancer started in your extrahepatic bile ducts, we may recommend the Whipple procedure.

• #4 Diagnosis of cholangiocarcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2504383/

  In unexplained biliary disease, CA 19-9 levels 100 UI/ml are considered suspicious for cholangiocarcinoma in the absence of an inflammatory process. […] The sensitivity of fluorodeoxyglucose positron emission tomography is limited in small, infiltrative, and mucinous cholangiocarcinomas. […] The diagnosis of cholangiocarcinoma remains difficult, despite the multiple diagnostic methods available.

• #4 Multimodal molecular imaging evaluation for early diagnosis and prognosis of cholangiocarcinoma | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-021-01147-7

  A retrospective study of 54 patients showed that the sensitivity, specificity, and accuracy of PET scanning for the diagnosis of CCA were 92.3%, 92.9%, and 92.6%, respectively. […] Therefore, 18F-FDG-PET/CT can provide additional staging information for the preoperative diagnosis of lymph node and distant metastasis, which is a supplement to conventional CT scan. […] The results showed that the sensitivity for the primary tumor was 58.8%, the sensitivity for lymph node and distant metastasis was 41.764.7% and 41.755.6%, respectively, and the specificity was 8086.7% and 87.595%, respectively. […] The sensitivity and specificity of MRI/MRCP for detecting PCCA are 8889% and 7585%, respectively, and CT are 7579% and 7980%, respectively. […] The emergence of PET/MR bimodal imaging technology has enabled functional molecular multi-parameter imaging.

• #4 Diagnosis of Cholangiocarcinoma

  https://www.mdpi.com/2075-4418/13/2/233

  The key blood biomarkers for the diagnosis of CCA are carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA). […] In the diagnosis of CCA, a blood CEA level greater than 5.2 ng/mL showed a sensitivity of 68% and a specificity of 82%. […] EUS can assess the regional lymph node status and the local extent of extrahepatic CCA. […] EUS-guided FNA can be performed to acquire tissue samples from tumors and enlarged lymph nodes. […] Brush cytology or biopsy of the suspicious lesion is conducted through ERCP or PTC. In a meta-analysis of 1,123 patients with CCA, the diagnostic sensitivity was 56% with brushing, 67% with biopsy, and 70.7% with brushing and biopsy combined.

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