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Bile Duct Tumor

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Mechanism of BileDuct Obstruction

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Bile duct tumors

Uncommon but serious problem

Tumor generally are small and difficult to visualized with US or CT or MRI

On average, patients are aged 60-65 yrs

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Types of bile duct tumors

Distal bile duct tumors

Proximal bile duct tumor (Klatskin’s tumors)

ProximalBD tumor

Distal BD tumor

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Periampullary Cancer

Distal bile duct cancer

Ampullary cancer

Pancreatic cancer

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Risk factors for bile duct cancer

Choledochal cyst

Polycystic liver

Parasitic infection: Liver fluke

Primary sclerosing cholangitis (PSC)

Ulcerative colitis

Biliary cirrhosis

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Sign and Symptom

Progressive jaundice (>90%)

Itchiness

Abdominal discomfort

Loss of appetite

Weight loss

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InvestigationBlood Test

LFT: suggestive of cholestasis Tumor markers CEA, CA 19-9

Imaging studies: Ultrasound: shows dilated bile duct, tumors mass may be

observed in 40% of cases as a hyperechoic lesion. CT scan: demonstrated bile duct, tumor mass may be difficult to

demonstrated, calcification may be obseved. MRI: add little to US and CT MRCP: providing images of bile duct and

pancreatic duct like ERCP Cholangiography: Percutanious transhpatic cholangiography

(PTC), Endoscopic retrograde cholangiopancreatography(ERCP)

Diagnostic procedure Percutaneous fine needle aspiration

(Provide definitive Dx in only 30-50% of patients) ERCP with biopsy: can detect an abnormality in 90% of patients Intraoperative cholangiography

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Treatment

Surgery: Curative: whipple procedurePalliative: bypass surgery, sphincterotomy and/or stent

placement via ERCPMedical: Palliative chemotherapy or RT haven’t been

proven to be of benefit : Symptomatic, supportive

Prognosis: Only 10-20% of tumors are resectable at presentation,

if resectable 5 yrs survival is 4-30%The anticipated course of most cases are

local spread recurrent biliary obstruction with infection death in 6-12 month

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Stent placement

Palliative treatment