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Review
. 2013 Jan;11(1):13-21.e1; quiz e3-4.
doi: 10.1016/j.cgh.2012.09.009. Epub 2012 Sep 13.

Classification, diagnosis, and management of cholangiocarcinoma

Nataliya Razumilava  1 , Gregory J Gores
Affiliations
Review

Classification, diagnosis, and management of cholangiocarcinoma

Nataliya Razumilava et al. Clin Gastroenterol Hepatol. 2013 Jan.

Abstract

Cholangiocarcinomas (CCAs) are tumors that develop along the biliary tract. Depending on their site of origin, they have different features and require specific treatments. Classification of CCAs into intrahepatic, perihilar, and distal subgroups has helped standardize the registration, treatment, and study of this lethal malignancy. Physicians should remain aware that cirrhosis and viral hepatitis B and C are predisposing conditions for intrahepatic CCA. Treatment options under development include locoregional therapies and a chemotherapy regimen of gemcitabine and cisplatin. It is a challenge to diagnose perihilar CCA, but an advanced cytologic technique of fluorescence in situ hybridization for polysomy can aid in diagnosis. It is important to increase our understanding of the use of biliary stents and liver transplantation in the management of perihilar CCA, as well as to distinguish distal CCAs from pancreatic cancer, because of different outcomes from surgery. We review advances in the classification, diagnosis, and staging of CCA, along with treatment options.

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Conflict of interest statement

Conflicts of interest: The authors disclose no conflicts.

Figures

Figure 1
Figure 1
Anatomic classification of CCA describing iCCA, pCCA, and dCCA.
Figure 2
Figure 2
Algorithm for diagnosis and management of patients with iCCA (A) and cirrhosis or (B) without cirrhosis.
Figure 3
Figure 3
Algorithm for diagnosis and management of pCCA. LN, lymph node.
Figure 4
Figure 4
(A and B) MRI and (C) MRCP images of pCCA (indicated by arrows) superimposed on PSC.
Figure 5
Figure 5
Algorithm for diagnosis and management of dCCA. LN, lymph node.
Figure 6
Figure 6
Key points in approach to CCA. FISH, fluorescent in situ hybridization.
See this image and copyright information in PMC

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