Cholangiocytoma Treatment

Cholangiocytoma is a very common disease in daily life, and intrahepatic cholangiocytoma is even more common. It is a malignant tumor that poses a direct threat to life safety. People need to understand its cause, and it is usually discovered in the late stage. But this does not mean that it is an incurable disease. As long as the right treatment method is chosen, health can be restored. Friends in need can learn the relevant knowledge.

1. Intrahepatic Cholangiocarcinoma

Intrahepatic cholangiocarcinoma is a malignant tumor of epithelial cells that originates in the secondary bile ducts and above in the liver. It is the second most common primary malignant tumor of the liver. In several worldwide epidemiological surveys in recent years, the incidence of ICC has shown an upward trend in various countries. There is controversy as to whether these data represent a true increase in incidence rather than simply an increase due to improved detection technology, such as pathological diagnosis. Some scholars believe that the improvement of diagnostic technology, such as ERCP, MRI, and CT, is a minor factor in the increase in incidence.

2. Causes

Similar to other tumors, although the cause of ICC is not yet clear, there are relatively certain high-risk factors, such as primary sclerosing cholangitis, hepatobiliary stones, parasitic infection, bile duct adenoma, bile duct papilloma, drug exposure and genetic factors, but basically they all have chronic inflammation of the bile duct as a common feature. In Western countries, primary sclerosing cholangitis is a widely recognized causative factor. About 40% of patients with primary sclerosing cholangitis have cancer. In East Asia, liver fluke is considered a risk factor associated with ICC with regional characteristics.

Intrahepatic stones are relatively rare in Western countries, but are a common disease in Asia, and more than 10% of patients with intrahepatic stones develop bile duct cancer. A study in Taiwan showed that more than 70% of patients undergoing surgery for intrahepatic cholangiocarcinoma were found to have hepatolithiasis during surgery. Some researchers believe that the link between stones and bile duct cancer lies in the mechanical irritation of the bile duct wall by intrahepatic stones or chemical irritation by infected bile. Other researchers have reported that repeated stimulation of intrahepatic stones can lead to atypical hyperplasia of the bile duct epithelium, thereby causing malignant transformation. Foreign studies have shown that intrahepatic stones in patients with cholangiocarcinoma are usually pigment stones, and the stones are mostly located inside or around the tumor, suggesting a pathological formation process of the tumor. Unlike pigment stones, the formation of which is mostly due to long-term chronic inflammation caused by bile duct congestion and bacterial infection, simple cholesterol stones are more related to congenital and metabolic factors, and it is very rare to be combined with bile duct cancer.

The increased incidence of diabetes, thyrotoxicosis, chronic pancreatitis, obesity, chronic non-alcoholic liver disease, HCV/HBV infection, chronic typhoid carriers, and smoking are all believed to partially explain the increased incidence of cholangiocarcinoma. Cirrhosis is considered to be a risk factor for bile duct cancer more than any other factor, about 10 times more than in the general population. Studies have shown that HCV/HBV, which has been identified as a risk factor for hepatocellular carcinoma, may also play a role in the development of cholangiocarcinoma.

3. Treatment recommendations

Unlike extrahepatic bile duct carcinoma, which has relatively obvious symptoms of bile stasis, such as jaundice, tea-colored urine, clayey stools, and skin itching, most ICC patients do not have typical clinical symptoms, but only non-specific symptoms such as abdominal pain, weight loss, general discomfort, and loss of appetite, making early detection very difficult. Generally speaking, MRCP, MRI, PET, three-dimensional imaging, CT, and tissue cell biopsy under ERCP can be used to assist diagnosis. Enzyme-linked immunosorbent assay (ELISA) such as CA199 has good sensitivity. However, most patients are diagnosed too late, and only palliative treatment is available when the disease is discovered. The mid-term survival time is only a few months, and the overall prognosis is poor, with a low 5-year survival rate and a high recurrence rate. The 5-year survival rate reported in various regions ranges from 13% to 42%.