Cholangiocarcinoma Symptoms, Imaging And Treatment

Cholangiocarcinoma is a cancer of the biliary ducts.  The biliary ducts carry bile from the liver to the intestine.  Bile helps with digestion.

Cholangiocarcinoma is a cancer that is often diagnosed on imaging studies like ultrasound, CT and MRI.  Diagnosis is confirmed with more invasive tests like ERCP and biopsies.

Cholangiocarcinoma is often diagnosed in advanced stages and has a poor prognosis.

What is cholangiocarcinoma?

Cholangiocarcinoma is a cancer that arises from the bile ducts.  The cancer can arise in the bile ducts of the liver or outside of it.

These cancers often arise in the elderly.

Risk factors include liver disease like cirrhosis and primary sclerosing cholangitis, infections, toxins, and stone disease to name some.

Cholangiocarcinoma symptoms

Symptoms include jaundice or yellowing of the eyes and skin, itchy skin, fatigue, abdominal pain on the right side below the ribs, weight loss, and dark urine to name some.

How is cholangiocarcinoma diagnosed?

Cholangiocarcinoma is often diagnosed on imaging studies like ultrasound, CT and MRI.  A focused MRI of the bile ducts called an MRCP provides the most detailed evaluation.

More invasive tests like ERCP and biopsies will be needed for definitive diagnosis in many cases.

What does cholangiocarcinoma look like on imaging?

Cholangiocarcinoma has three presentations.

(1) It can look like a mass in the liver.

(2) The cancer can develop along the bile duct walls.  This presentation most commonly develops in the liver hilum.  The hilum is where blood vessels and bile ducts enter the liver.  The mass typically obstructs the bile ducts.  The mass may be difficult to see on imaging.

(3)  The third presentation of cholangiocarcinoma is of a mass along the bile duct.   Usually the bile duct is dilated on imaging.

There can be some mixture of the above types as well.

What else can look like cholangiocarcinoma in radiology?

Since cholangiocarcinoma has different appearances on imaging, the differential diagnosis includes many entities.

For mass forming cholangiocarcinoma, other liver tumors and metastasis are in the differential diagnosis.

For Cholangiocarcinoma which grows along the walls of the bile ducts, other benign strictures or narrowings of the bile ducts can be considered.  The lack of a mass or tumor spread favors a benign stricture.

For the intraductal cholangiocarcinoma, consider other masses or stones of the bile ducts.

What causes cholangiocarcinoma?

The cells that line the bile ducts have a change in their DNA.  This causes the cells to grow out of control and form a tumor.  While there are risk factors for development of cholangiocarcinoma, it is not known what causes the changes to the DNA that cause a tumor to form.

What type of doctor treats cholangiocarcinoma?

Treatment may be complex with a combination of surgery, chemotherapy and radiation therapy.  Multiple specialists to include gastroenterologists, oncologists and surgeons may be involved.

Cholangiocarcinoma treatment

Treatment may consist of surgery for tumors which have not spread.  Other options for more advanced tumors include targeted therapies, chemotherapy, radiation therapy, immunotherapy and transplantation.

Cholangiocarcinoma: summary

Cholangiocarcinoma is a cancer of the bile ducts.  Cholangiocarcinoma is often suspected on imaging.  The imaging appearance can be that of mass in the liver or abnormalities of the bile ducts in or outside the liver.

Biopsies may be needed for definitive diagnosis.   The tumor is often found in advanced stages and carries a poor prognosis.  Treatment is complex and may involve multiple specialists.