Materiały źródłowe

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

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

  Cholangiocarcinoma is a type of cancer that forms in the slender tubes (bile ducts) that carry the digestive fluid bile. Bile ducts connect your liver to your gallbladder and to your small intestine. […] 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.

• #2 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: […] Tumor marker tests: These tests check your blood or urine for tumor markers substances that might mean you have cancer. High levels of carbohydrate antigen (CA) 19-9 or carcinoembryonic antigen (CEA) may be signs of bile duct cancer. […] 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 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. […] Moreover, several serum tumor markers (carbohydrate antigen 19-9 and carcinoembryonic antigen) can be useful in diagnosing CCA in some patients. […] The key blood biomarkers for the diagnosis of CCA are carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA).

• #4 Get Bile Duct Cancer Treatment | Cleveland Clinic

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

  Your test results help us confirm whether you have cancer. They also help us learn about the cancers stage, if its spread and what treatments could offer the best results. […] When you learn you may have bile duct cancer, its important to feel confident that you have a team of healthcare providers you trust on your side. […] Our expert cancer specialists will take the time to help you better understand your diagnosis and treatment options. […] Cancer treatment relies on the experience and input of providers from many different specialties. […] No two cancers are the same. Thats why we tailor your treatment to match your needs. […] Your care plan is based on where the cancer is, if its spread (stage) and your overall health. […] Depending on your test results, we may recommend a variety of treatment options.

• #5 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 guideline writing committee included a multidisciplinary team of experts from various specialties involved in the management of CCA, as well as patient/public representatives from AMMF (the Cholangiocarcinoma Charity) and PSC Support. Quality of evidence is presented using the Appraisal of Guidelines for Research and Evaluation (AGREE II) format. The recommendations arising are to be used as guidance rather than as a strict protocol-based reference, as the management of patients with CCA is often complex and always requires individual patient-centred considerations. […] 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.

• #6 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. […] Cholangiocarcinomas (bile duct cancers) arise from the epithelial cells of the bile ducts. […] Although they are rare in the United States, these cancers are highly lethal because most are locally advanced at presentation. […] Extrahepatic biliary tract malignancies were traditionally divided into cancers of the gallbladder, the extrahepatic ducts, and the ampulla of Vater, whereas intrahepatic tumors were classified as primary liver cancers. […] More recently, the term cholangiocarcinoma has been used to designate bile duct cancers arising in the intrahepatic, perihilar, or distal (extrahepatic) biliary tree, exclusive of gallbladder and ampulla of Vater.

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

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

  Recent Advancement in Diagnosis of Biliary Tract Cancer through Pathological and Molecular Classifications […] The development of various molecular techniques has led to the introduction of a new classification for biliary tract cancer and a better understanding of the clinicopathological features of the disease. […] Furthermore, as new diagnostic modalities and research findings have been published, they enable accurate diagnoses, differentiations, and clinical assessments based on the characteristics of each subtype. This article reviews the current imaging and histologic diagnostic techniques along with future perspectives on molecular diagnosis, to approach precision medicine for biliary tract cancer. […] Biliary tract cancers (BTCs), including intrahepatic, perihilar, and distal cholangiocarcinomas, as well as gallbladder cancer, are a diverse group of cancers that exhibit unique molecular characteristics in each of their anatomic and pathological subtypes. […] The pathological classification of BTCs compromises distinct growth patterns, including mass forming, periductal infiltrating, and intraductal growing types, which can be identified through gross examination. […] The presentation of typical clinical symptoms, as well as the extensive utilization of radiological, endoscopic, and molecular diagnostic methods, is thoroughly detailed in the description. […] To overcome the limitations of traditional tissue acquisition methods, new diagnostic modalities are being explored.

• #8 Clinical manifestations and diagnosis of cholangiocarcinoma – UpToDate

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

  Approximately 5 to 10 percent of cholangiocarcinomas are intrahepatic. […] Intrahepatic cholangiocarcinomas can originate from either small intrahepatic ductules (peripheral cholangiocarcinomas) or large intrahepatic ducts proximal to the bifurcation of the right and left hepatic ducts. […] The extrahepatic bile ducts are divided into perihilar (including the confluence itself) and distal segments, with the transition occurring proximal to the cystic duct. […] Cancers arising in the perihilar region, which account for 60 to 70 percent of extrahepatic cholangiocarcinomas, have been further classified according to the pattern of involvement of the hepatic ducts (the Bismuth-Corlette classification). […] Type IV tumors, defined as tumor invasion of the second order biliary radicles bilaterally, are associated with a higher rate of positive surgical margins and significantly poorer overall survival after resection compared with types I to III.

• #9 Bile Duct Cancer (Cholangiocarcinoma): Symptoms. Causes, Tests, Treatments

  https://www.webmd.com/cancer/bile-duct-cancer

  Bile Duct Cancer Diagnosis […] Your doctor will start with a physical exam. Theyll ask about your general health, family history of cancer and liver disease, lifestyle, and habits, including drinking and smoking. Theyll also check for masses, tenderness, or fluid buildup in your belly. […] Certain tests can find signs of bile duct cancer, including: […] Blood tests. Some of these will tell your doctor whether your liver is working the way it should. Others look for signs of tumors, called markers. Your doctor may also check your levels of bilirubin, which can cause jaundice when you have a lot of it. […] Abdominal ultrasound. This imaging test helps your doctor look for tumors. […] CT scan or MRI. A CT scan is a powerful X-ray that makes detailed pictures inside your body. An MRI uses high-powered magnets to show organs and other things inside your body. If you have a tumor, these can show its size and location, as well as how healthy your liver is.

• #10 Get Bile Duct Cancer Treatment | Cleveland Clinic

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

  While you could have an infection, these symptoms can also signal a rare and aggressive type of cancer that grows in your bile duct called cholangiocarcinoma (bile duct cancer). […] If you learn you may have this cancer, youll want to get the best possible care from expert healthcare providers who use the latest tools and therapies to diagnose and treat this condition. […] Bile duct cancer (cholangiocarcinoma) is a rare cancer that starts in your bile ducts. It often grows quickly and quietly. So by the time you have symptoms, theres a chance its already spread to other parts of your body. […] After we spend some time talking, your provider will do a physical exam to check your overall health and any noticeable symptoms. Theyll also order some tests to help confirm a diagnosis. […] Many different tests can help us pinpoint whats happening, so we can build your custom treatment plan.

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

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

  If you have symptoms that suggest you may have bile duct cancer, its vital that your doctor has a clear and complete understanding of whats causing them. […] When making a diagnosis, our experts take the time to learn about your medical history and understand your overall health. […] Diagnosing bile duct cancer may begin with a test to measure the amount of bilirubin in the blood. […] A high bilirubin level can lead to jaundice (a yellowing of the skin and the whites of the eyes) and mean that the liver or bile ducts are not functioning properly. […] Other blood tests measure levels of liver enzymes (such as alkaline phosphatase, AST, ALT, and GGT) and can identify abnormal amounts of other substances (such as CEA and CA 19-9). […] Finding any of these substances in the blood can indicate the presence of bile duct cancer.

• #12 Cholangiocarcinoma: Symptoms, Causes, Types, Staging & Treatment PACE Hospitals – Best Hospitals in Hitech City, Hyderabad, India | Near Madhapur, Kukatpally, KPHB, Kondapur, Gachibowli, Jubilee Hills, Banjara HillsPACE Hospitals Contact

  https://www.pacehospital.com/cholangiocarcinoma-bile-duct-cancer-symptoms-causes-types-staging-treatment

  Cholangiocarcinoma (CCA), also called bile duct cancer, is an uncommon but aggressive malignancy that arises from the epithelial cells lining the bile ducts. Cholangiocarcinoma accounts for approximately 3% of all gastrointestinal malignant cancers but is associated with a high mortality rate due to its late-stage diagnosis and limited treatment options. […] The disease is often asymptomatic in its early stages, leading to delayed detection and poor prognosis. Some of the commonly seen symptoms are jaundice, pruritus, abdominal pain, and weight loss. […] Though there are advancements in the diagnosis and treatment of cholangiocarcinoma, curative options remain restricted, making early detection and targeted therapies a crucial focus of ongoing research. […] Since cholangiocarcinoma often presents with non-specific symptoms, early and accurate diagnosis requires a combination of imaging, laboratory tests, and histopathological confirmation.

• #13 SSA – POMS: DI 23022.704 – Cholangiocarcinoma – 08/09/2023

  https://secure.ssa.gov/apps10/poms.nsf/lnx/0423022704

  Cholangiocarcinoma is a cancer that develops in the cells within the thin tubes (bile ducts) that bring the fluid that helps you digest food (bile) from the liver and gallbladder to the small intestine. […] Cancer that occurs within the bile ducts is categorized as biliary tract cancer (BTC) and can occur in the bile ducts both inside and outside the liver. […] Cholangiocarcinoma is rare. About 8,000 people in the U.S. develop this cancer each year. It can occur at any age, but most commonly affects people older than 50. […] The condition is often diagnosed when it is advanced, making successful treatment difficult. […] Diagnostic testing: A diagnosis of cholangiocarcinoma may be made using: Liver function tests; Tumor marker tests; Abdominal ultrasound; Magnetic resonance cholangiopancreatography (MRCP); Endoscopic retrograde cholangiopancreatography (ERCP); Percutaneous transhepatic cholangiography (PTC); or Biopsy.

• #14 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 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. Bilirubin is the chemical that causes jaundice. Problems in the bile ducts, gallbladder, or liver can raise the blood level of bilirubin.

• #15 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.

• #16 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. […] Moreover, several serum tumor markers (carbohydrate antigen 19-9 and carcinoembryonic antigen) can be useful in diagnosing CCA in some patients. […] The key blood biomarkers for the diagnosis of CCA are carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA).

• #17 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 combined use of CEA and CA 19-9 may improve the diagnosis of cholangiocarcinoma, but this has not been reproduced in all studies. […] 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. […] Further studies comparing the accuracy of the various imaging methods, especially the new intraductal methods, are needed, and the imaging features of malignancy should be standardized.

• #18 Diagnosis of Cholangiocarcinoma

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

  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. […] EUS-guided FNA can be performed to acquire tissue samples from tumors and enlarged lymph nodes. […] EUS-guided FNA is more sensitive than ERCP with brushings for diagnosing extrahepatic CCA. […] The combination of an elevated CA 19-9 and a positive brush cytology showed a sensitivity and specificity of 88% and 97%, respectively. […] For extrahepatic CCA, EUS or ERCP is recommended as the next step in the evaluation process. […] 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.

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

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

  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. […] Due to the distinct anatomical location of BTC, bile is recognized as a promising body fluid for diagnosing BTCs. […] Molecular profiling is recommended for advanced diseases and is considered suitable for systemic treatments. […] Parallel tests for several genes using focused NGS are preferred over single-gene sequencing. […] In patients with PSC and suspected cholangiocarcinoma, CA 19-9 levels greater than 129 U/mL were found to be 79% sensitive and 98% specific in confirming the diagnosis. […] However, the positive predictive value for cholangiocarcinoma, which is the likelihood of a patient with PSC and a CA 19-9 level of ≥129 unit/mL having the disease, was only 57%. […] BTC is a heterogeneous disease that arises from the biliary tree. […] The development of radiologic and endoscopic tools for accurate diagnosis strengthens our understanding of BTC carcinogenesis. Precision medicine for BTC patients is facilitated by pathological and molecular profiling.

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

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

  At MSK, we use the latest imaging techniques to pinpoint the exact size and location of newly diagnosed bile duct tumors. […] These details help us determine whether a tumor can be removed by surgery. […] Imaging helps guide our surgeons and interventional radiologists during many kinds of procedures. […] CT scans take cross-sectional pictures of the body, helping doctors determine if the cancer cells are only in the bile duct or if they have spread to other areas. […] Ultrasound is useful for detecting the location and number of tumors and whether the tumor involves the main blood vessels. […] This technique uses MRI to show how much a tumor has grown within the bile duct. […] We may do other tests to learn more about the extent of the tumor and the types of cells involved. […] During a biopsy, a doctor removes a small amount of tissue from the area where the cancer is suspected.

• #21 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. […] People with bile duct cancer may have high blood levels of the markers called CEA and CA 19-9. High levels of these markers often mean cancer is present, but the high levels can also be caused by other types of cancer, or even by problems other than cancer. […] Imaging tests can often show a bile duct blockage. But they often cant show if the blockage is caused by a tumor or by a less serious problem like scarring. […] If you have (or might have) bile duct cancer, you could have one or more of these tests: […] 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.

• #22 Cholangiocarcinoma (bile duct cancer) | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/cholangiocarcinoma-bile-duct-cancer/

  Cholangiocarcinoma is often diagnosed when it’s advanced, making successful treatment difficult to achieve. […] If your doctor suspects cholangiocarcinoma, he or she may have you undergo one or more of the following tests: […] Liver function tests. Blood tests to measure your liver function can give your doctor clues about what’s causing your signs and symptoms. […] Tumor marker test. 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. […] 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).

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

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

  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. […] 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.

• #24 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). This can help show if someone might have a tumor that’s blocking a duct. […] If imaging tests show a tumor in the bile duct, the doctor may decide to proceed directly to surgery and to treat the tumor as a bile duct cancer. […] There are many ways to take biopsy samples to diagnose bile duct cancer. […] 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. […] Along with looking at the biopsy samples with a microscope to see if they contain cancer cells, other lab tests might also be done on the samples.

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

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

  The initial step in diagnosing BTC is to identify the anatomical location and growth patterns, followed by a microscopic assessment of the differentiation and subtype. […] Several classifications have been proposed based on the anatomical location, histopathological appearance, and molecular characteristics of BTC. […] The most common imaging pattern of mass-forming iCCA in both CT and MRI is characterized by an arterial peripheral rim enhancement that progresses centripetally with homogeneous contrast agent uptake, which continues until the delayed phase or remains stable during the late dynamic phases. […] 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. […] Recently, MRCP or CT scanning, which is non-invasive and highly accurate, has largely replaced invasive cholangiography for diagnostic purposes.

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

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

  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. […] Before undertaking any endoscopic investigations for a suspected CCA, all patients should have undergone a triple-phase CT scan of the abdomen/pelvis and chest along with dynamic MRI and MRCP if proximal biliary obstruction is suspected. […] Patients with operable distal malignant tract obstruction (DMTO) should undergo a combination of endoscopic US and endoscopic retrograde cholangiopancreatography (ERCP) to try to confirm a malignant histological diagnosis before proceeding to surgery.

• #27 Gallbladder & Bile Duct Cancer (Cholangiocarcinoma) – UChicago Medicine

  https://www.uchicagomedicine.org/cancer/types-treatments/gallbladder-bile-duct-cancer

  Ultrasound: To identify an obstruction or tumor in the bile ducts and find a mass or tumor associated with the gallbladder. […] Computed tomography (CT): To detect a tumor inside the gallbladder or bile duct and show if it has spread outside of the organ to the liver, bile duct or nearby lymph nodes. […] Magnetic resonance imaging (MRI): To create more detailed images of the liver and bile ducts than a CT or ultrasound can provide. An MRI can show if a tumor is only in the gallbladder or has spread to the liver. […] Endoscopic ultrasound (EUS): Involves a flexible tube, equipped with a camera and other tools, that is passed down through the mouth, esophagus and stomach into the small intestine. […] Endoscopic retrograde cholangiopancreatography (ERCP): Similar to endoscopic ultrasound, ERCP also involves a flexible tube, equipped with camera and other tools, passed down through the mouth, esophagus and stomach into the small intestine.

• #28 Tests for Bile Duct Cancer Diagnosis and Detection

  https://www.cancercenter.com/cancer-types/bile-duct-cancer/diagnosis-and-detection

  Magnetic resonance imaging scans may be able to distinguish between benign (noncancerous) and malignant (cancerous) tumors. […] A cholangiogram is an imaging test designed to identify abnormalities such as a block, narrowing or dilation (widening) of the bile duct. […] This outpatient procedure similar to endoscopic ultrasound and is used to reach the bile or pancreatic duct where X-ray images are taken to recognize problems in the bile duct. […] This outpatient procedure uses a thin, hollow needle to access the bile duct through the skin. […] An MRCP may provide the care team with images that help detect potentially cancerous areas.

• #29 Bile Duct Cancer – Cholangiocarcinoma – Gastrointestinal Cancer | UCLA Health Jonsson Comprehensive Cancer Center

  https://www.uclahealth.org/cancer/cancer-services/gi-cancer/conditions/bile-duct-cancer

  Minimally invasive interventional endoscopy: Endoscopy shows your doctor the tiny bile ducts, gallbladder and liver. Interventional endoscopists can remove bile duct stones or take a tissue sample (biopsy) without surgery. […] Percutaneous transhepatic cholangiography (PTC): PTC uses a dye (contrast medium) so that your doctor can see bile duct blockages on an X-ray. During the procedure, the doctor may take cell samples or biopsy tissue. If there is a blockage, the doctor may insert a stent (a drain or tube) to open the duct.

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

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

  In a suspected case of operable distal CCA, in the absence of jaundice, a standalone endoscopic ultrasound (EUS) scan should be undertaken first, to avoid the complications of ERCP, which could delay or render the patient inoperable. […] In the presence of jaundice and DMTO, where EUS is not available, patients may only be able to have an ERCP and brush cytology in the first instance to confirm the presence of a CCA. […] At present biliary biomarkers cannot be recommended as a replacement for cytological and histological standards. However, biliary next-generation sequencing shows great promise and should be taken forward for replicative National Institute for Health Research/UK Research and Innovation (NIHR/UKRI) funded multisite studies. […] It should be realised that a cytological/histological confirmation of a malignant biliary tract obstruction (MBTO) is imperfect at present, and in cases where uncertainty remains, a decision on follow-up imaging versus surgery for a definitive diagnosis should be reached only after a full discussion between the patient and the clinician. These guidelines acknowledge that it is acceptable to offer surgery where histological confirmation cannot exclude malignancy with absolute certainty and surgery might provide a cure and a secure diagnosis.

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

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

  No patient with a perihilar CCA should undergo endotherapy until the case has been fully discussed at an HPB treatment centre. […] Unilateral drainage in the future remnant lobe should be considered ahead of surgery. Bilateral/further stenting should only be considered if the level of preoperative jaundice does not improve, or there is cholangitis in residual obstructed biliary segments. […] Inoperable perihilar CCA – proximal malignant tract obstruction (PMTO) and jaundice should be considered for palliative stenting by either ERCP or PTC. […] At present the use of adjunctive endobiliary radiofrequency ablation (RFA) and photodynamic therapy is not considered standard of care for patients with hilar and distal CCA receiving palliative care. […] EUS guided biliary drainage is recognised as a treatment option, but use of this technique should be planned at a MDT meeting with units adopting this approach able to show clear audit data in relation to alternative and more traditional methods of biliary drainage.

• #32 Bile Duct Cancer (Cholangiocarcinoma): Symptoms. Causes, Tests, Treatments

  https://www.webmd.com/cancer/bile-duct-cancer

  Endoscopy. This uses a tool called an endoscope thats like a camera on the end of a cable. It lets your doctor see inside your body without surgery. They can look at your esophagus, your stomach, and the beginning of your lower intestine. […] Cholangioscopy. This procedure helps check your bile ducts for problems. In ERCP, or endoscopic retrograde cholangiopancreatography, your doctor uses an endoscope to inject dye into your bile ducts. They then take X-rays to look for tumors. […] Magnetic resonance cholangiopancreatography (MRCP). This uses an MRI machine to make images of your bile ducts. […] Percutaneous transhepatic cholangiography (PTC). Your doctor inserts a needle through your skin and into a bile duct in your liver. They inject dye and take an X-ray of the area. […] Laparoscopy. Your doctor uses medication to put you to sleep and then makes a small cut in your belly. They insert a thin tube with a light and a video camera to look at your bile duct, gallbladder, liver, and other organs and tissues. […] Biopsy. Your doctor takes a sample of bile duct cells or tissue, and a technician checks them under a microscope. They might do this during a laparoscopy.

• #33 Clinical manifestations and diagnosis of cholangiocarcinoma – UpToDate

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

  The most recent (2017) revision of the tumor, node, metastasis (TNM) classification no longer considers type IV tumors to represent a T4 primary tumor. […] […] […] The diagnostic approach to cholangiocarcinoma includes the need for tissue diagnosis and tumor staging. […] Specific tests for diagnosis include serologic tests, imaging studies, endoscopy, and percutaneous cholangiography. […] Serologic tests may include tumor markers such as CA 19-9, CEA, and alpha-fetoprotein. […] Imaging studies may involve ultrasound, MDCT, MRI, and MRCP. […] Endoscopy and percutaneous cholangiography may include cholangiography, endoscopic ultrasound, intraductal ultrasound, and cholangioscopy. […] […] […] Algorithms for diagnosis include approaches for patients with and without primary sclerosing cholangitis (PSC). […] Tables provide TNM staging for distal, perihilar, and intrahepatic bile duct cancers. […] Diagnostic images illustrate cholangiocarcinoma as seen on MRCP and ERCP procedures.

• #34 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. […] In order to plan treatment, it is important to know if the bile duct cancer can be removed by surgery. […] 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: […] Different procedures may be used to obtain a sample of tissue and diagnose bile duct cancer. […] Cells and tissues are removed during a biopsy so they can be viewed under a microscope by a pathologist to check for signs of cancer. […] Types of biopsy procedures include: […] A sample of tissue is removed and checked for signs of cancer. […] This procedure may be used when a person cannot have surgery. […] Once bile duct cancer has been diagnosed, the prognosis (chance of recovery) and treatment options depend on: […] Treatment options may also depend on the symptoms caused by the cancer. Bile duct cancer is usually found after it has spread and can rarely be completely removed by surgery.

• #35 Cholangiocarcinoma – Diagnosis & Disease Information

  https://www.cancertherapyadvisor.com/ddi/cholangiocarcinoma/

  Histopathological confirmation through biopsy is essential for definitive diagnosis. This involves obtaining tissue samples via percutaneous fine-needle aspiration, endoscopic ultrasound-guided biopsy, or surgical resection. […] Confirmatory tests such as cytology, molecular profiling, and immunohistochemistry help characterize the tumors type and grade, which will guide treatment decisions. […] Factors affecting laboratory results and diagnostic accuracy include the tumors location, size, and stage, as well as the presence of biliary obstruction or inflammation, which can complicate interpretation and sampling.

• #36 Cholangiocarcinoma – Wikipedia

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

  Immunohistochemistry is useful in the diagnosis and may be used to help differentiate a cholangiocarcinoma from hepatocellular carcinoma and metastasis of other gastrointestinal tumors. […] 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. […] Surgical exploration may be necessary to obtain a suitable biopsy and to accurately stage a person with cholangiocarcinoma.

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

  https://www.cancerresearchuk.org/about-cancer/bile-duct-cancer/getting-diagnosed/tests-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. […] PET scans show a 3 dimensional (3D) picture of the inside of your body. It uses a mildly radioactive drug to show up areas of your body where cells are more active than others. You might have a PET scan to help diagnose bile duct 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.

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

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

  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. […] 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.

• #39 Bile Duct Cancer (Cholangiocarcinoma) | Cancer Support Community

  https://www.cancersupportcommunity.org/bile-duct-cancer

  A sample of cells or tissues is removed and viewed under a microscope to check for signs of cancer. The sample may be taken using a thin needle inserted into the duct during an x-ray or ultrasound. This is called a fine-needle aspiration biopsy (FNA.) The biopsy is usually done during PTC or ERCP, where a brushing of the bile duct can be taken. […] Biomarkers are features of your tumor that can be measured to help guide treatment. In recent years, doctors have learned more about the biology of cancer. They have found specific changes in a gene or cell that help cancer grow and spread. They have developed new drugs to treat cancers with these changes. […] Your doctor will test your blood for the presence of CEA and CA 19-9. These are proteins secreted by cancer cells. The tests can often predict if cancer is growing and spreading. Testing is done at diagnosis and again later in treatment. Doctors sometimes use this measure to see how well treatment is working.

• #40 Cholangiocarcinoma (Bile Duct Cancer): Staging and Treatment | OncoLink

  https://www.oncolink.org/cancers/gastrointestinal/cholangiocarcinoma/cholangiocarcinoma-bile-duct-cancer-staging-and-treatment

  Staging is the process of learning how much cancer is in your body and where it is. Tests like biopsy, ultrasound, CT, MRI, and PET scan may be done to help stage your cancer. Your providers need to know about your cancer and your health so that they can plan the best treatment for you. […] Staging for bile duct cancer is based on: The size of your tumor seen on imaging tests and what is found after surgery. Surgery to test if your lymph nodes have cancer cells. Any evidence of spread to other organs (metastasis). […] The staging system for cholangiocarcinoma is called the TNM system. The staging has three parts: T-describes the size/location/extent of the „primary” tumor in the bile duct. N-describes if the cancer has spread to the lymph nodes. M-describes if the cancer has spread to other organs (called metastases).

• #41 Bile Duct Cancer (Cholangiocarcinoma) Treatment: Treatment – Patient Information [NCI] | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.bile-duct-cancer-cholangiocarcinoma-treatment-treatment-patient-information-nci.ncicdr0000258011

  Different procedures may be used to obtain a sample of tissue and diagnose bile duct cancer. Cells and tissues are removed during a biopsy so they can be viewed under a microscope by a pathologist to check for signs of cancer. The type of procedure used depends on whether the person is well enough to have surgery. […] Once bile duct cancer has been diagnosed, the prognosis (chance of recovery) and treatment options depend on: whether the cancer is in the upper or lower part of the bile duct system, the stage of the cancer (whether it affects only the bile ducts or has spread to the liver, lymph nodes, or other places in the body), whether the cancer has spread to nearby nerves or veins, whether the cancer can be completely removed by surgery, whether the person has other conditions, such as primary sclerosing cholangitis, whether the level of CA 19-9 is higher than normal, whether the cancer has just been diagnosed or has recurred (come back). […] To learn about the tests and procedures used to diagnose and stage bile duct cancer, see Bile Duct Cancer Diagnosis.

• #42 Cholangiocarcinoma (Bile Duct Cancer): Staging and Treatment | OncoLink

  https://www.oncolink.org/cancers/gastrointestinal/cholangiocarcinoma/cholangiocarcinoma-bile-duct-cancer-staging-and-treatment

  There are 3 different staging systems for bile duct cancers, depending on where they start: Intrahepatic bile duct cancers: The cancer started in the liver. Perihilar (hilar) bile duct cancers: The cancer started in the hilum, the area just outside the liver. Distal bile duct cancers: The cancer started farther down the bile duct system. […] The staging systems are very complex. Below is a summary. Talk to your provider about the stage of your cancer.

• #43

  https://winshipcancer.emory.edu/cancer-types-and-treatments/bile-duct-cancer/symptoms.php

  Bile duct cancer is rare and there are no screening tests to detect the disease. […] Given the location of the bile ducts deep within the abdomen, there are currently no bile duct cancer screening tests available to check for the disease before symptoms appear. […] Patients with a diagnosis of primary sclerosing cholangitis should remain in surveillance with their hepatologist to screen for the development of bile duct cancer. […] Given their location deep inside the abdomen, bile duct tumors are difficult to detect at early stages before symptoms are present. […] Some cholangiocarcinomas are diagnosed incidentally, meaning as a result of imaging tests for another condition. […] Others are diagnosed when a person experiences symptoms of bile duct cancer and goes to the doctor for evaluation. […] The sooner bile duct cancer is diagnosed, the better your prognosis may be.

• #44 What Is Bile Duct Cancer (Cholangiocarcinoma)? – NCI

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

  Bile duct cancer is a rare disease in which malignant (cancer) cells form in the bile ducts. Bile duct cancer is also called cholangiocarcinoma. […] There are no routine screening tests to check for bile duct cancer before signs and symptoms occur. To learn about tests that are used to diagnose bile duct cancer, see Bile Duct Cancer Diagnosis.

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

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

  Patients should have a clear monitoring pathway for early detection of recurrent stent blockage and on-demand endoscopic intervention. […] High-resolution cross-sectional imaging is essential for assessment of resectability and accurate staging. […] Preoperative preparation, including augmentation of the functional liver remnant (FLR) and biliary drainage, may be required to ensure safe resection. […] R0 resection is the only curative treatment available. […] Surgical resection of CCA should be undertaken only at high-volume centres with expertise across all relevant supporting specialties, including interventional radiology, endoscopy, hepatobiliary medicine, oncology and pathology. […] Liver transplantation for selected patients with perihilar CCA (pCCA) in the presence of chronic liver disease (most commonly primary sclerosing cholangitis), less than 3 cm in size with no evidence of extrahepatic disease, results in long-term disease-free survival.

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

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

  All patients diagnosed with CCA should have timely access to high-quality information and should be directed to a dedicated CCA patient charity so that they can access support and information. […] All patients with CCA should be enabled to access a second specialist clinical opinion if they need to seek reassurance about either their diagnosis or treatment.

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