The Complexity Of Handling Kolangiokarsinoma

Ten years ago, said Manhal Izzy, MD, this approach may seem odd: perform a liver transplant on a patient with cancer of the bile duct (kolangiokarsinoma) intrahepatik beginning. Now, however, the development has moved a long way.

Dr. Izzy, Assistant Professor of medicine, Faculty of medicine, Vanderbilt University, and an expert on transplant hepatology, Vanderbilt University Medical Center, trying hard to appreciate the wisdom and the work of those in the field of Hepatology and Oncology which has put forward an approach for healing kolangiokarsinoma. Given the prognosis is very bad, he said, the physician-scientist is open to new directions.  "This is a very aggressive tumor, " said Dr. Izzy. At a time when the patient shows symptoms,  "everything is often already too late." and when they seek medical care,  "almost over."

The Complexity Of Handling Kolangiokarsinoma

Five-year survival rate without treatment, less than 10 percent.  "It does change from time to time, " said Sumera Rizvi, MBBS, Assistant Professor of medicine, Faculty of medicine, Division of Gastroenterology and hepatology, Mayo Clinic. kolangiokarsinoma has increased over the past few decades.

The latest approach of using neoadjuvant chemoradiation before transplantation. A study of 12 Central (Darwish Murad S, et al. Gastroenterology. 2012; 143 [1]: 88-98. e3) who observed patients with kolangiokarsinoma perihilar shows survival rates of non recurrence of 78 percent. each of the five years, post transplant. (Survival after liver transplantation, neoadjuvant therapy, without is around 20 percent, said Dr. Rizvi, citing data from the years 1990 's.)

"Everyone is looking at the prognosis for these tumors," said Dr. Izzy, "so everyone wants to try to find something new," both in diagnostic or therapy.

the first step is mastering the basics kolangiokarsinoma. Although this is the most common biliary malignancy and liver malignancy the second most common, the numbers are still low enough to be considered rare. It's hard to get mastery over an issue that is rarely found, said Rondell Graham, MBBS, molecular GI pathologist, Mayo Clinic. Low incidence is one reason why kolangiokarsinoma tend to be misunderstood. In fact,  "this very different genetic Profile, " said Dr. Kipp,  "that it actually represents three different diseases."

Kolangiokarsinoma perihilar arising between two order of the bile duct and cystic duct insertions. This accounted for about half of the kolangiokarsinoma. Kolangiokarsinoma distal appears below the insertion of the cystic duct and accounts for about 30 percent of cases.

Kolangiokarsinoma intrahepatik appears above the bile duct the second order. These are usually found incidentally, in patients who may have chronic liver disease or cirrhosis and was undergoing a routine audit of the CAT scan or ultrasound, which showed a mass lesion intrahepatik. This accounted for 20 pikanrsen from kolangiokarsinoma.

The first two types of diagnostic modality is the focus of the laboratory-based, including cytology biliary and FISH. Diagnosis can be a challenge, said Dr. Graham, "because there is no affirmative markers specific for kolangiokarsinoma. We rely heavily on morphology. "

19-9 CA levels were very high associated with metastatic kolangiokarsinoma, said Dr. Izzy.  "So it gives the impression, instructions, about the extent of the disease when it is very high." but some cancers — a subset called the Lewis antigen-negative — do not remove bookmarks, so that normal levels cannot be used to override the disease, he warned.

It's not unusual, said Dr. Rizvi, a person who is notified that they are suffering from cancer of the bile duct on the basis of a suspicious cytology.  "They will come to us, but in the ERCP repeated we don't see a suspicious cytology and/or polisomi FISH, and we can not confirm or find other confirmation criteria. It is a situation that we sometimes encounter. "

Kolangiokarsinoma perihilar and distal is the most challenging in Diagnostics, said Dr. Izzy.  "You need some modalities in addition to imagery, " including endoscopy and biopsy and cytology of both FISH.  "However, you may not be able to confirm or exclude a diagnosis, " Dr Izzy.

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