RECENT UPDATES IN MANAGEMENT OF CHOLANGIOCARCINOMA

Abstract

Cholangiocarcinoma is a malignant tumor of the bile ducts, and it is a rare tumor. The majority of the tumor is ductal adenocarcinoma (95%) and the rest is squamous cell carcinoma. It has no confined symptoms and signs, but jaundice is the most common clinical pictures. Some laboratory findings are found, as Hyperbilrubinemia. Estimation of tumor marker stays disputable, but may be used as carbohydrate antigen 19-9 (CA 19-9). Ultrasonography and CT scan also may give more help in diagnosing a tumor mass. MRI/MRCP has a great sensitivity in diagnosing a malignant bile obstruction. ERCP is helpful to diagnose a malignant stricture and also in a therapeutic use. New modalities are updated to ensure the diagnosis, such as endoscopic ultrasonography, Fine needle aspiration guided by the EUS, Fluorescent in situ hybridization with digital imaging study. The best treatment of cholangiocarcinoma is the surgical one, unless the tumor is unresectable. Unfortunately, the tumor first presentation is late and most of patients show unresectable tumor. So many palliative measures are described for those patients, as percutaneous placement of expandable metal stents for drainage, Photodynamic therapy, intra-luminal brachytherapy, Chemotherapy and radiotherapy. Recently targeted therapies are described and showing promising results. Key words: Cholangiocarcinoma, diagnosis, management, surgical resection and palliative.