Colangiocarcinomul

Colangiocarcinomul

    * Introduction
    * Causes and Risk Factors
    * Signs and symptoms
    * Diagnosis
    * Treatment
Colangiocarcinomul or bile duct cancer is a slow-growing malignant tumor. Is the second primary tumor after liver hepatoma. Triggering causes malignant process are still unclear. Epidemiological studies have shown the involvement of bacteria-inducing carcinogens in the pathogenesis colangiocarcinomului. Ductal bile Caculii appear only 20-50% of patients, however colangiocarcinomul association with ductal gallstones is less marked than one with gallbladder cancer.
Most common cause of malignant biliary obstuctiei is adenocarcinoma. Gallbladder carcinoma is three times more often than the bile duct.
Colangiocarcinomul is associated with Clonorchis sinensis infection, because the most commonly found worldwide.
Intrahepatic tumors can cause abdominal pain, palpation of a mass, weight loss and jaundice. Abdominal pain is the most common symptom, is found in 47% of patients, while only 12% painless jaundice. Obstructive jaundice occurs in 90% of colangiocarcinoame and evolve gradually with itching and anorexia. Duration of symptoms is usually short, a few months. Some may apacienti cholangitis or cholecystitis.
Therapeutic interventional techniques in biliary tract can be performed percutaneous or endoscopic. Preferred treatment for biliary obstruction caused by a cystic lesion is distal bile duct endoscopic biliary drainage. Despite aggressive anticancer therapy and interventional techniques, the average survival rate is low. Most patients, 90% not suitable for curative resection. The survival rate is 6 months.
Under 20% of tumors are resectable. Periampulare distal extrahepatic tumors are resectable with 5-year survival rates of 39%. The survival rate in patients with proximal tumors resected is 5-15%.
Pathogenesis
Like most of the digestive system tumors, primary biliary tumors are carcinomas. There are several histological types, among which the most encountered is adenocarcinoma, mucinous carcinoma and papillary carcinoma. Histological grade varies from well differentiated to undifferentiated till. Except chistadenocarcinomului, tumors are composed of clusters of cells, sometimes surrounded by stroma desmplastica. Desmoplastic stroma is the formation of fibrous tissue around the tumor cells, the body's response to tumor invasion. This feature is intilita in patients with cholangitis, intraductal gallstones or ductal stents.
The most common malignant tumor diagnostic tests are inumohistochimice for citokeratina, carcinoembrionic antigen and mucin.
Other types of tumors occur in less than 5% of cases. These include: squamous cell carcinoma, small cell carcinoma and mesenchymal tumors.
Colangiocarcinoamele tend to grow slowly and infiltrate the ductal walls, dissecting along tissue plans. Local extension occurs in the liver, porta hepatis, and regional lymph nodes of the celiac and pancreaticoduodenal chains. The evolution can occur cholangitis requiring biliary drainage and immediate antibiotic therapy aggressively, being a life-threatening pathological condition.