Principles of diagnosis and treatment in cholangiocarcinoma

Abstract

Background. Cholangiocarcinoma (CCA) is an aggressive biliary tract malignancy with a high incidence globally, accounting for 15% of all liver cancers. CCA is a clinically silent disease, that manifests itself in advanced stages. Mortality rises to 20%. Objective of the study. Analysis and evaluation of the efficacy and limitations of current diagnostic modalities and therapeutic approaches for CCA. Material and methods. This study is a review of 32 literature sources about CCA, found in the PubMed, Medline, Google Scholar and clinical guidelines with a focus on evaluating imaging techniques, tumor markers, biopsy methods, systemic, targeted and surgical treatment. Results. Risk factors for CCA - cirrhosis, sclerosing cholangitis, and trematode infection. Diagnosis is based on clinical symptoms, laboratory and paraclinical investigation. Tumor biomarkers- CA 19-9, CEA and α-fetoprotein are > in CCA. Best methods of investigation are CT- identify and evaluate locoregional or metastatic disease, MRCP- provides the best noninvasive imaging of CBD, EUS visualizes the portal structures, lymph nodes and guided biopsies with a higher sensitivity. The overall prognosis for CCA is poor. A multidisciplinary team must be involved in the patient’s care from the time of diagnosis. Only 1/4 of patients have resectable tumors. Treatment strategies differ among CCA locations: hepaticojejunostomy in upper CBD tumor, Whipple surgery in tumor of distal CBD, liver transplantation being an option for highly selected patients with hilar CCA or intrahepatic CCA. In unresectable disease is used systemic and targeted therapies. Conclusion. Early detection is crucial due to poor survival rates. Initial diagnosis typically involves imaging along with elevated CA19-9 levels, while a confirmatory biopsy. Treatment primarily depends on the resectability of the CCA. Liver transplantation is the option that decreased poor prognoses for CCA.