What Is Cholangiocarcinoma?
Cholangiocarcinoma is also called bile duct cancer. It is relatively rare in comparison to other cancers, such as lung or breast cancer. It begins from the epithelial cells (a type of cell that covers the surfaces of the body parts) lining the bile ducts. The bile ducts help in transporting bile from the liver to the intestine, where it aids in digestion.
Cholangiocarcinoma can occur at different locations along the biliary tree. According to the location of occurrence, it is categorized into three subtypes: intrahepatic, distal, and perihilar cholangiocarcinoma. Each subtype has unique characteristics and challenges, making accurate diagnosis and treatment necessary. Furthermore, in the early stages of the disease, it often remains asymptomatic, making it challenging to detect and diagnose promptly.
What Is Cholangiocarcinoma With Intraductal Growth?
Cholangiocarcinoma with intraductal growth is a subtype of cholangiocarcinoma characterized by intraductal growth within the bile ducts. Due to its distinctive growth pattern, this subtype presents a unique challenge to healthcare professionals and patients. The intraductal growth is generally multifocal; they may or may not have mucin secretion macroscopically. They can be of any kind of pathological transformation, from invasive carcinoma to low-grade dysplasia. These features are biliary papillomatosis, mucin-hypersecreting bile duct tumor, mucin-producing cholangiocarcinoma, and biliary intraductal papillary mucinous neoplasm.
Cholangiocarcinoma with intraductal growth has better outcomes when compared with common cholangiocarcinoma. This intraductal growth pattern can cause various clinical presentations, symptoms, and complications, making it an intriguing disease in oncology. Cholangiography and cholangioscopy are required to confirm the pathology and check the extent of the lesions. Pathological diagnosis cannot reflect the actual stage of carcinoma because mixed pathologic findings may exist in the same lesion.
What Are the Symptoms of Cholangiocarcinoma With Intraductal Growth?
Cholangiocarcinoma with intraductal growth usually presents with nonspecific symptoms, which can confuse healthcare professionals during early diagnosis.
A few of the most common signs and symptoms of cholangiocarcinoma with intraductal growth include:
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Jaundice - The skin and eyes will appear yellow due to the build-up of bilirubin in the body. Bilirubin is a yellowish pigment produced during the breakdown of red blood cells (RBC). Jaundice is one of the most noticeable and earliest symptoms of cholangiocarcinoma.
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Pale Stools and Dark Urine - Changes in stool and urine color are another common and noticeable symptom. It occurs due to the disruption of bile flow.
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Itchy Skin - Itchy skin can be noted in patients with cholangiocarcinoma because of bile duct obstruction and the bile salts accumulation in the bloodstream.
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Abdominal Pain - Frequent pain can occur in the upper right quadrant of the abdomen. This pain may be mistakenly linked with other gastrointestinal conditions, leading to delayed diagnosis.
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Unexplained Weight Loss - Unexplained weight loss can be noted in many cancer conditions. It is due to cancer affecting energy expenditure and the body's metabolism.
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Fatigue - It is another common complaint among cholangiocarcinoma patients.
How Is Cholangiocarcinoma With Intraductal Growth Diagnosed?
Cholangiocarcinoma with intraductal growth diagnosis can be challenging, as the disease often mimics other conditions, and its symptoms are often nonspecific in the initial stage. A combination of blood tests, imaging studies, and invasive procedures are required to confirm a diagnosis.
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Blood Tests - A liver function test may be required to assess the liver functioning and may also indicate the presence of inflammation or obstruction. Tumor markers, such as CA19-9, are also elevated in 25 % of cases of cholangiocarcinoma but are not specific to the disease.
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Imaging Studies - Radiological imaging, such as magnetic resonance imaging (MRI), computed tomography (CT) scans, and endoscopic retrograde cholangiopancreatography (ERCP), can provide required information about the bile ducts and any possible abnormalities. ERCP is useful for visualizing the inside of the bile ducts.
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Biopsy - This is the gold standard method for diagnosing cholangiocarcinoma. Tissue samples are collected and analyzed under a microscope to check for the presence of cancer cells and provide information about their subtype and staging.
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Cholangiography - It is an imaging technique of the bile duct. It helps show the entire bile duct to check the extent of the intraductal growth. Diffuse dilation of the bile duct and amorphous filling defects in the bile duct are characteristic features of cholangiocarcinoma with intraductal growth in cholangiography.
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Cholangioscopy - It is a procedure to examine and treat problems inside the bile duct. Percutaneous transhepatic cholangioscopy (PTCS) and peroral cholangioscopy (POCS) help to check the bile duct directly and extend and confirm the histology of the lesions to check that the treatment provided is appropriate.
What Is the Treatment for Cholangiocarcinoma With Intraductal Growth?
The treatment for cholangiocarcinoma with intraductal growth involves a multidisciplinary approach. Also, the treatment may vary depending on the cancer stage, the patient’s age, overall health, and other factors.
Here are some of the primary treatment modalities:
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Surgery - Surgical resection is the best treatment, especially for early-stage tumors. Sometimes, a portion of the liver resection, along with the affected bile duct and adjacent lymph nodes, may be needed.
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Radiation Therapy - High-energy X-rays target and destroy cancer cells in this therapy. Radiation therapy may be used before surgery to shrink tumors or after surgery to eliminate any remaining cancer cells.
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Chemotherapy - Drugs kill cancer cells or stop their growth in this therapy. Chemotherapy is often done in combination with other treatments, such as surgery or radiation therapy.
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Targeted Therapy - Targeted therapies use specific drugs to target cancer cells by interfering with cell growth and division. This therapy is considered for patients with specific genetic mutations.
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Liver Transplantation - Liver transplantation may be recommended to patients with cholangiocarcinoma limited to the liver meeting the criteria for liver transplantation.
Conclusion
Cholangiocarcinoma with intraductal growth is a rare but distinct subtype of cancer. It has a unique intraductal growth pattern complicates the diagnosis and treatment planning. Early detection is very hard as this condition does not have specific symptoms, making diagnosis challenging in the early stages.
A multidisciplinary treatment approach, including surgery, radiotherapy, and chemotherapy, is essential for improving outcomes and patient quality of life. The prognosis for cholangiocarcinoma with intraductal growth can vary depending on the stage at diagnosis. In the early stages, the prognosis is more favorable, while in the advanced stage, the prognosis is poor.
