What is the basis for the diagnosis of bile duct cancer

What is the basis for the diagnosis of bile duct cancer? Regardless of the disease, examination and diagnosis are indispensable before treatment, because this is also the standard for doctors to judge the application of treatment methods and understand the specific condition of the patient. So how to diagnose bile duct cancer? What is the basis for diagnosis?

1. Jaundice occurs in 90% of patients, gradually deepens, and the stool is grayish white, which may be accompanied by anorexia, fatigue, and anemia. Half of the patients have itchy skin rashes and weight loss. The minority of patients without jaundice mainly have upper abdominal pain, and abdominal masses can be felt in the late stage.

2. Enlarged gallbladder: The enlarged gallbladder in the middle and lower segments may be palpable, and the Murphy sign may be negative, while the gallbladder in the upper bile duct cancer is not palpable.

3. The liver can be touched under the rib margin in case of hepatomegaly. If jaundice lasts for a long time, ascites or edema of both lower limbs may occur. Tumor invasion or compression of the portal vein may cause portal hypertension and upper gastrointestinal bleeding. Late-stage patients may develop hepatorenal syndrome and have oliguria or anuria.

4. Biliary tract infection presents typical symptoms of cholangitis: right upper abdominal pain, chills, high fever, jaundice, and even shock; the most common bacteria are Escherichia coli, Streptococcus faecalis, and anaerobic bacteria. Endoscopic or interventional radiological examinations may induce or aggravate the infection.

5. Laboratory tests showed that serum total bilirubin, direct bilirubin, ALP and y-GT were significantly elevated, while ALT and AST were only slightly abnormal. Biliary obstruction causes vitamin K absorption disorders, liver synthesis of coagulation factors is blocked, and prothrombin time is prolonged. Serum tumor markers CA19-9 may be elevated, while CEA and AFP may be normal.

6. Imaging examination ① Ultrasound examination is the first choice, which can show dilatation of intrahepatic bile duct or bile duct tumor; color Doppler ultrasound examination can understand whether the portal vein and hepatic artery are invaded; endoscopic ultrasound probe has a high frequency and can avoid the interference of intestinal gas, and the accuracy of examining the depth of infiltration of middle, lower and hilar cholangiocarcinoma is 82.8% and 8500 respectively. PTC examination can also be performed under ultrasound guidance, and bile can be extracted by puncture for CEA, CA19-9, bile cytology examination and direct puncture tumor biopsy. ② ERCP is only helpful for the diagnosis of lower bile duct cancer, or for the placement of internal stents for drainage before surgery. ③ CT and MRI can show the location of bile duct obstruction, the nature of lesions, etc. Among them, three-dimensional spiral CT cholangiography and magnetic resonance cholangiopancreatography (MRCP) will gradually replace invasive examinations such as PTC and ERCP. ④ Radionuclide development scanning and angiography help to understand the relationship between cancer and blood vessels.

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