Cholangiocarcinoma

The most common type of this is an adenocarcinoma, typically forming at the perihilar region of the liver (where both hepatic ducts join to form the common hepatic duct). Risk factors for it include:

• Primary Sclerosing Cholangitis (risk with UC)

• Liver flukes (parasitic infection)

The main presenting symptom is painless obstructive jaundice - dark urine, pale stools, itchiness. O/E. there'll be a palpable gallbladder.

N.B. Courvoisier’s Law - Palpable gallbladder + jaundice is unlikely to be due to gallstones, and is usually a cholangiocarcinoma or pancreatic cancer.

Investigaitons:

• Same as for pancreatic cancer:

  • USS

  • CT/MRI

  • LFTs

  • CA19-9

  • MRCP/ERCP

Management:

• Most present too late for curative surgery to be an option, so palliative tends to be the route taken. This includes stenting, chemo/radiotherapy, EOL care w/symptom control.