Cholangiocellular liver cancer diagnosis and treatment

Cholangiocellular liver cancer manifests itself quite rarely, but if treatment is not started on time, serious complications may develop. The probability of death is high.

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What is cholangiocellular liver cancer?

Cholangiocarcioma of the liver is a malignant formation in the bile ducts. The development of the disease is caused by the deposition of cancer cells on the walls of the bile ducts, which contributes to the appearance of carcinoma in the organ.

According to the ICD 10 (international classification of diseases of the tenth revision), cholangiocarcinoma is on the list of malignant organ and intrahepatic biliary tract formations.

The bile duct is a thin tube (up to twelve centimeters in size). Serves as a connecting channel between the liver and the small intestine. The pathway is designed to drain bile from the glands of external secretion into the intestines, which contributes to better absorption of food by the stomach.

The duct consists of three elements:

  • the first is located inside – small tubes that collect bile from organ cells. The tubular channels merge in stages, creating two channels,
  • intrahepatic duct – dispersed over the tissues of the glands of external secretion. Consists of two channels that merge at the outlet of the organ, creating a single duct,
  • a connecting tube between the liver and intestines.

Cancer cells originate in the epithelial particles of the bile.

Types and prevalence

Cholangiocellular carcinoma is classified by type. The classification is due to the location of the origin of the carcinoma.

The following types are known:

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  • Intrahepatic. The onset of a malignant tumor occurs in small bile ducts that penetrate the tissue of the organ. The type of this disease is similar to hepatocellular carcinoma, its effect is directed on the cells of the organ. The intrahepatic form is quite rare, observed in one out of ten cases of cholangiocellular cancer. The intrahepatic type is divided into: massive, periproduct-infiltrating, intraductal.
  • Intrathoracic. The neoplasm manifests itself in two large bile ducts merging at the gate of the liver. The most common type of disease. It is observed in six out of ten cases of manifestation of the disease.
  • Distal. Cancer cells develop in the distal part of the duct at the site of fusion with the small intestine. Carcinoma spreads outside the organ (extrahepatic). This violation manifests itself in two out of ten cases.

Malignant tumors are distinguished by the characteristic signs of growth:

  • infiltrative, formed cancer cells lead to damage to neighboring tissues of the body or the gallbladder,
  • polypoid, manifests itself inside the canal – it is fixed on the wall with the help of a “leg”,
  • exophytic neoplasm, an increase in the tumor contributes to its exit beyond the walls of the bile duct,
  • mixed form, three signs of a tumor occur simultaneously.

According to statistics, cholangiocarcinoma of the liver and bile ducts is manifested in 3% of cases from all kinds of cancer of the gastrointestinal tract.

The greatest distribution is observed in Southeast Asia. In Europe, North America, there are about three cases of cholangiocarcinoma per one hundred thousand people, in Japan – 5,5, in Israel – 7. It most often manifests itself at the age of 50-70 years, women are more common among the cases.

In the last 30 years, there has been a significant increase in cholangiocarcinoma disease in people aged 45 and above. Scientists believe that this is due to the negative impact on the body of the latest methods of machine diagnostics, as well as many negative factors conducive to cancer.

Causes and symptoms

The reasons contributing to the development of cholangiocarcinoma are:

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  • gallstone pathology,
  • chronic cholestatic syndrome,
  • cyst of bile ducts,
  • inflammation of the colon, rectum,
  • the effect of radioactive thorium dioxide,
  • cirrhosis of the glands of external secretion,
  • violation of the metabolism of carbohydrates and water in the body (diabetes mellitus),
  • genetic predisposition, when observing a disease in the family – the danger of the manifestation of the disease increases fourteen times.

Pathology in the initial stages practically does not manifest itself in anything. There is a possibility of probing a minor tumor in the area of ​​the hepatic ducts.

But there are obvious symptoms that clearly indicate the presence of the disease:

  • skin cover, mucous membranes, the outer shell of the eyes acquire a yellowish color. The symptom depends on the location of the malignant tumor. The richer the color, the larger the neoplasm,
  • the presence of pain syndromes due to the transmission of infection by the bile. As a result, inflammation of the ducts develops, accompanied by chills, malaise, pain in the body,
  • general weakness of the body, fatigue, discomfort, uncontrolled weight loss.

Diagnostics

The most commonly used methods for diagnosing cholangiocarcinoma are:

  • CT scan,
  • ultrasound procedure.

If it is impossible to identify the disease with these types of diagnostics, endoscopic retrograde cholangiopancreatography or magnetic resonance cholangiopancreatography is used.

Endoscopic retrograde cholangiopancreatography can detect malignant carcinoma and biopsy the tissue with a brush.

This procedure performs histological diagnosis without the use of fine-needle biopsy, guided by computed tomography or ultrasound. Also used in contrast-enhanced computed tomography.

Treatment and prognosis

The prognosis of survival in cholangiocarcioma is one of the most unfavorable. For effective treatment, surgical intervention is required at the initial stages of the disease. But the problem is that it is almost impossible to detect cancer particles at this stage.

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To relieve pain symptoms, palliative methods of therapy are used:

  • stenting,
  • chemotherapy,
  • radiation therapy.

A qualitative result of the treatment is observed when performing surgical changes or transplanting infected parts. In the absence of such opportunities, endoprostheses are used to prevent blockage of the bile ducts.

This leads to an improvement in the patient’s condition, relieves itching, and reduces the likelihood of developing purulent canal lesions.

With cholangiocarcinoma, a slow development of malignant formation is observed. According to statistics, with this diagnosis, the sick live from fourteen months to five years.

With the development of a tumor outside the glands of external secretion, the operation contributes to obtaining positive changes, which leads to an increase in life expectancy.

If an inoperable tumor is found and there are metastases, it is possible to use exclusively palliative therapy. Its results help prolong life up to several weeks.

Distant metastases with the manifestation of cancerous elements in the bile ducts develop slowly, therefore they are not the main cause of death of the patient.

The presence of pathologies most often leads to death:

  • biliary cirrhosis of the glands of external secretion,
  • purulent inflammation of tissues, arising from infections occurring in the glands of external secretion,
  • exhaustion of the whole organism,
  • sepsis.

VIDEO

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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