Bile Duct Tumor

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  • 1. Bile Duct Tumor

2. Mechanism of Bile Duct Obstruction 3. Bile duct tumors

  • Uncommon but serious problem
  • Tumor generally are small and difficultto
    • visualized with US or CT or MRI
  • On average, patients are aged 60-65 yrs

4. Types of bile duct tumors

  • Distal bile duct tumors
  • Proximal bile duct tumor (Klatskins tumors)

Proximal BD tumor Distal BD tumor 5. Periampullary Cancer

  • Distal bile duct cancer
  • Ampullary cancer
  • Pancreatic cancer

6. Risk factors for bile duct cancer

  • Choledochal cyst
  • Polycystic liver
  • Parasitic infection: Liver fluke
  • Primary sclerosing cholangitis (PSC)
  • Ulcerative colitis
  • Biliary cirrhosis

7. Sign and Symptom

  • Progressive jaundice (>90 % )
  • Itchiness
  • Abdominal discomfort
  • Loss of appetite
  • Weight loss

8. Investigation

  • Blood Test
      • LFT: suggestive of cholestasis
      • Tumor markers CEA, CA 19-9
  • Imaging studies :
      • Ultrasound: shows dilated bile duct, tumors mass may be
  • observed in 40% of cases as a hyperechoic lesion.
      • CT scan: demonstrated bile duct, tumor mass may be difficult to
  • demonstrated, calcification may be obseved.
      • MRI: add little to US and CT
      • MRCP: providing images of bile duct and
      • pancreatic duct like ERCP
      • Cholangiography: Percutanious transhpatic cholangiography
  • (PTC), Endoscopic retrograde cholangiopancreatography
  • (ERCP)
  • Diagnostic procedure
      • Percutaneous fine needle aspiration
  • (Provide definitive Dx in only 30-50% of patients)
      • ERCP with biopsy: can detect an abnormality in 90 %of patients
      • Intraoperative cholangiography

9. Treatment

  • Surgery :
  • Curative: whipple procedure
  • Palliative: bypass surgery, sphincterotomy and/or stent
  • placement via ERCP
  • Medical : Palliative chemotherapy or RT havent been
  • proven to be of benefit
  • : Symptomatic, supportive
  • Prognosis :
  • Only 10-20 %of tumors are resectable at presentation,
  • if resectable 5 yrs survival is 4-30%
  • The anticipated course of most cases are
        • local spread
        • recurrent biliary obstruction with infection
        • death in 6-12 month

10. 11. Stent placement Palliative treatment