Cholangiocarcinoma: Symptoms and Treatment
Cholangiocarcinoma is a type of oncopathology that forms in the bile ducts and has a malignant course and an unfavorable prognosis. The main symptoms of the disease are manifested due to obstruction of the bile duct. Among all oncological pathologies of the gastrointestinal tract, cholangiocarcinoma accounts for about 3%, that is, the tumor is quite rare and predominantly occurs in middle-aged and older women.
In medical practice, there are several types of bile duct tumor. It is classified as a neoplasm by such criteria as:
- growth pattern
- microscopic structure.
Depending on the location of the cholangiocarcinoma may be intrahepatic — this form of the disease is said in the case when the neoplasm begins to form in the smallest ducts beginning inside the liver. In its clinical manifestations, this form of pathology is like cholangiocellular liver cancer, so treatment will be the same for them.
The second form of the oncology of the bile ducts is the intrathoracic, in which the tumor is formed directly in the hepatic gates, where the two ducts join together into a common one. It is this tumor that occurs most often in cancer of the bile ducts — it is called the Klatskin tumor.
And the third form, depending on the location of the neoplasm, distal cholangiocarcinoma. With this form, the tumor develops in the closest part to the small intestine of the bile duct.
By the nature of growth, exophytic, infiltrative, polypoid and mixed forms of cholangiocarcinoma are isolated. Exophilic cholangiocarcinoma is a tumor growing from the inside out of the duct, infiltrative — growing in all directions and germinating in the gallbladder and surrounding tissues and organs. Polypoid — growing inside the duct, which has a leg, which is attached to the wall. A mixed tumor has the signs of all the above-described forms, therefore it is the most difficult to treat. By its microscopic structure, the neoplasm in the liver can be intrinsic, periprotic-infiltrating or massive.
The causes of this pathology, such as cholangiocarcinoma, have not yet been elucidated. In some people predisposing factors contribute to the development of the tumor, and in others, the presence of such factors in the anamnesis is not revealed, therefore it is impossible to say unequivocally who is in the risk zone. Nevertheless, the most likely causes for the development of this malignant disease in humans are:
- congenital anomalies that caused the bile duct to malfunction;
- exposure to chemicals that destroy liver tissue and bile ducts
- sclerosing cholangitis
- bile duct cyst and other hereditary diseases of the biliary tract
- Crohn’s disease;
The risk of developing a tumor such as cholangiocarcinoma increases in those cases where people suffer from cirrhosis or liver failure. In addition, the effect on the formation of a tumor in the bile ducts of the human hepatitis virus is not ruled out.
Various pathologies of the gastrointestinal tract can also provoke the development of this pathology. In general, it is assumed that the cholangiocarcinoma of the liver develops as a result of mechanical or toxic damage to cells in the organ.
The bile ducts in their lumen are small enough, so even with a slight obstruction of the tumor, there is a violation of the outflow of bile from the bladder, which leads to the development of mechanical jaundice. It is mechanical jaundice that is the first symptom of this disease, but its appearance does not speak directly about the tumor, as it can develop in other diseases of the liver and gallbladder.
Also a person may be disturbed by symptoms such as:
- skin itching
- skin swelling
- loss of appetite
- weight reduction
- change in color of feces and urine (urine darkens, feces discolor)
Usually, with such a tumor, a person suffers from vomiting, as well as symptoms of poisoning — fever, weakness, muscle pain, drowsiness, apathy, etc.
Cancer causes the development of the inflammatory process in the ducts — cholangitis, which leads to pain in the right hypochondrium, hyperthermia and febrile syndrome.
When the tumor progresses, the symptoms increase, and depending on the stage, the formation is operable and inoperable. In addition, the prognosis of the treatment of the disease depends on the stage at which the tumor was detected — if it is detected at the initial stages, the probability of successful treatment with the use of surgical methods and chemotherapy is great. If the tumor is found in the late stages — the forecast is unfavorable and many patients are prescribed only palliative treatment.
Diagnosis and treatment features
The diagnosis of cholangiocarcinoma is based on patient complaints, laboratory and instrumental research methods. Patients are assigned biochemical tests, but they do not have a pronounced diagnostic value, therefore, it is shown that such research methods as:
- definition of specific oncomarkers;
- ultrasound of the liver and gallbladder
- retrograde cholecystography
- transhepatic percutaneous cholangiography
Differential diagnostics should be carried out with such ailments as viral hepatitis, cirrhosis, leptospirosis and some others.
Treatment of cholangiocarcinoma should be complex and include surgery to remove the tumor and affected tissues, as well as the appointment of radiation and chemotherapy to deactivate metastases. In those cases when the tumor is small, its operative removal is shown without a part of the affected organ. When it is large, the proportion of the liver is removed.
Very often, cholangiocarcinoma is found in those stages when it already sprouts into neighboring tissues and organs. Therefore, mainly with this diagnosis, a more extensive surgical intervention is performed — removal of part of the liver, duodenum and stomach, gallbladder with ducts, as well as pancreatic and affected lymph nodes. After such a radical surgical intervention, people can not fully recover, so the prognosis is extremely unfavorable. And with less extensive intervention, the forecast gives a person a maximum of a year and a half. True, if cholangiocarcinoma is detected at an early stage, there is a high probability of five-year survival of patients. However, cases of diagnosis of the tumor in the early stages of a single.
With regard to conservative treatment, it consists in the appointment of chemotherapy in an individual dose. Chemotherapy is also performed for patients who can not remove the tumor with surgery. The forecast in this case is unfavorable — a person has a half-year or a year depending on the stage of development of the process.