Cholangiocarcinoma
One third of all liver and biliary passage tumors are tumors of the intrahepatic and extrahepatic ducts. Tumors can originate in large collecting ducts, such as the bile ducts and hepatic ducts, or smaller ducts throughout the liver.
Associated Conditions
Diseases associated with bile duct tumors include liver fluke infections, gallstones (which may cause persistent irritation of the ducts), ulcerative colitis, and primary sclerosing cholangitis. Less commonly associated diseases include cystic liver disease and Carolis disease.
Detection
People with a malignant tumor in a hepatic duct often have symptoms that are similar to those of advanced primary liver cancer. Because blockage of the ducts is common, a characteristic symptom of hepatic duct cancer is new-onset jaundice. Jaundice is a yellowish coloring of the skin that results from excess bile.
Blood tests by themselves may not detect liver duct cancer. Additional tests may be necessary.
Duct tumors may be detected during evaluations prompted by complaints of gastrointestinal pain or discomfort. A computed tomography (CT) scan may discover a dilated bile duct. During an endoscopic examination of the gastrointestinal tract, a gastroenterologist may detect a tumor or note a narrowing of a duct. Such a narrowing could indicate the presence of a tumor. This examination is called endoscopic retrograde cholangiopancreatography (ERCP).
Evaluation
If an ERCP yields evidence of a tumor, the gastroenterologist may use a brush to take a tissue sample during the ERCP. The sample will undergo a biopsy.
Blood tests may not by themselves detect liver duct cancer. Additional tests may be necessary.Additional evaluations include cholangiography, enhanced CT scans, an angiogram (to determine blood vessel involvement and blood flow to the tumor), and an MRI cholangiogram. These tests provide information about the extent and location of the tumor, its proximity to major hepatic blood vessels, whether the tumor is spreading, and the quality of liver function. Knowing the location of the tumor is important because tumor location helps determine the course of treatment.
Blood tests to measure bilirubin levels may be needed to determine whether a tumor is blocking the duct. If tests indicate increased bilirubin and duct obstruction, specialists may place a stent, or tube, in the duct to relieve the blockage. As a result of this procedure, bilirubin levels should return to normal.
For patients who will be treated by chemotherapy, an audiogram (hearing test) and a MUGA heart scan may be required.