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Diagnosis and Treatment of Cholangiocarcinoma

Cholangiocarcinoma (also called cholangioma or bile duct cancer) is a rare, malignant tumor of the bile duct, accounting for fewer than 1% of all cancers. Cholangiocarcinoma is a type of adenocarcinoma ("adeno" for gland) that originates in the mucous glands of the epithelium, or surface layer, of the bile ducts.

Bile ducts are channels that carry bile or "gall" from the liver where it is secreted to the gall bladder for storage. The bile is discharged in the duodenum (the first 1/3 of the small intestine) primarily to aid digestion by emulsifying fats.  The bile ducts start as small tributaries in the liver and merge into larger ducts.  This ultimately leading to the common hepatic duct which then leaves the liver and attaches to the gall bladder via the cystic duct and then empties into the duodenum via the common bile duct. The pancreatic duct which delivers pancreatic enzymes to the intestines to help digestion, also enters the duodenum at the same site and sometimes merges with the common bile duct before entering the duodenum.

Cholangiocarcinomas can therefore arise within the liver (i.e. intra-hepatic) or in the bile ducts just outside the liver.  The disease can spread along the bile ducts thereby involving both the liver and the pancreas, gall bladder or duodenum.  They can also spread to adjacent lymph nodes, spread to liver or lungs via the blood or simply "seed" the abdomen with tumor cells landing on other abdomenal organs (e.g. bowel, bladder, rectum, ovaries).  The latter "seeding" process is called intra-peritoneal dissemination and is quite common with this disease.

Therefore, some some cholangiocarcinomas are true primary liver tumors in that they may originate in the liver, while others may spread there or to adjacent organs (including pancreas) through the bile ducts. 

More than two thirds of cholangiocarcinomas are located in either the common hepatic duct (CHD) or the common bile duct (CBD). The CHD -- where the right and left ducts from the liver meet to form one channel on to the duodenum -- is the most likely location for a cholangiocarcinoma, and the CBD -- the channel from the gallbladder formed by union of the hepatic duct and the cystic duct -- is the second most common location for a cholangiocarcinoma.

Risk Factors
Primary sclerosing cholangitis, a condition in which there is chronic inflammation and scarring of the bile ducts can result in cholangiocarcinoma

Causes, Treatment, and Diagnosis

Although several diseases of the liver and bile ducts can predispose you to developing intrahepatic cholangiocarcinoma, by far the majority of individuals who develop these tumors have no known risk factors.

Primary liver cancer occurs four times more often in South East Asia than in either North America or in Western Europe. Symptoms may include pain in your upper right abdominal area. Diagnosis and treatment require a sophisticated approach in order to rule out other types of tumors.

Stanford Expertise

A Team Approach
Stanford offers you an exceptional spectrum of services whether you have intrahepatic or extrahepatic cholangiocarcinoma.

Your Stanford Cancer Center oncologist, gastroenterologist, or liver specialist can provide access to the Stanford Liver Tumor Board, Liver Tumor Clinic, and the Stanford Asian Liver Center utilizing the most comprehensive team approach to achieve your diagnostic and treatment goals.

Advanced Technology
Radiologists at the Stanford Cancer Center are continually pioneering the use of advanced imaging techniques that improve both diagnosis and treatment of liver cancer and cholangiocarcinomas. You can be assured that by receiving care at our center, you will have access to the most advanced technologies available.

For example, the Stanford Cancer Center also is one of the only places in the U.S. to pioneer Stereotactic Radiosurgery for more precise doses of radiation that may be appropriate for cholangiocarcinoma.

Cholangiocarcinoma can sometimes be treated with a liver transplant. If your treatment team determines that this is the best approach for your particular situation, your Stanford physician can refer you to our Transplant Center, which has survival rates that exceed the national average.

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