cholangiocarcinoma, gallbladder cancer, common bile duct, cystic duct, intrahepatic, perihilar

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Transcript of cholangiocarcinoma, gallbladder cancer, common bile duct, cystic duct, intrahepatic, perihilar

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    Overview of the affected part

    The gall bladder and the bile duct are part of the digestive system. Together, the esophagus,

    stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the

    nutritive components of food into energy and break down the non-nutritive components into

    waste to be excreted.

    Anatomy and Physiology of the Gallbladder and Bile Ducts

    The anatomy of the biliary tree is a little complicated, butit is important to understand. The liver's cells(hepatocytes) excrete bile into canaliculi, which areintercellular spaces between the liver cells. These draininto the right and left hepatic ducts, after which biletravels via the common hepatic and cystic ducts to thegallbladder. The gallbladder, which has a capacity of 50milliliters (about 5 tablespoons), concentrates the bile 10fold by removing water and stores it until a person eats.

    At this time, bile is discharged from the gallbladder viathe cystic duct into the common bile duct and then intothe duodenum (the first part of the small intestine),where it begins to dissolve the fat in ingested food.

    The liver excretes approximately 500 to 1000 milliliters (50 to 100 tablespoons) of bile eachday. Most (95%) of the bile that has entered the intestines is resorbed in the last part of thesmall intestine (known as the terminal ileum), and returned to the liver for reuse.

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    The many functions of bile are best understood by knowing the composition of bile:

    1. Bile Salts (cholates, chenodeoxycholate, deoxycholate): these are produced by the liver'sbreakdown of cholesterol. They function in bile as detergents that dissolve dietary fatand allow it to be absorbed. Hence, disruption of bile excretion disrupts the normalabsorption of fat, a process called malabsorption. Patients develop diarrhea because thefat is not absorbed (steatorrhea) , and develop deficiencies of the fat-soluble vitamins(A, D, E, and K).

    2. Cholesterol and phospholipids-while only 4% of bile is cholesterol, the secretion ofcholesterol and its metabolites (bile salts) into bile is the body's major route ofelimination of cholesterol. Phospholipids, which are components of cell membranes,enhance the cholesterol solubilizing properties of bile salts. Inefficient excretion ofcholesterol can cause an increased serum cholesterol. This predisposes to vasculardisease (heart attacks, strokes, etc.)

    3. Bilirubin-while this comprises only 0.3% of bile, it is responsible for bile's yellow color.Bilirubin is a product of the body's metabolism of hemoglobin, the carrier of oxygen inred blood cells. Disruption of the excretion of this component of bile leads to a yellow

    discoloration of the eyes and skin (jaundice).4. Protein and miscellaneous components

    Bile production and recirculation is the main excretory function of the liver. Tumors thatobstruct the flow of bile from the liver can also impair other liver functions. Therefore, it isnecessary to understand these other functions to understand the symptoms that these tumorscan cause. These include:

    Metabolic functions, such as the maintenance of glucose (blood sugar) levels

    Synthetic functions, such as the synthesis of serum proteins such as albumin, bloodclotting (coagulation) factors, and complement (a mediator of inflammatory responses)

    Storage functions, such as the storage of sugar (glycogen), fat (triglycerides), iron,copper, and fat soluble vitamins (A, D, E, and K)

    Catabolic functions, such as the detoxification of drugs

    The biliary system is comprised of the organs and duct system that create, transport, store and

    release bile into the duodenum for digestion. Includes the liver, gallbladder and bile ducts

    (named the cystic, hepatic, common, and pancreatic duct).

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    the bile duct, which is a 4-inch to 5-inch tube that connects the liver and gallbladder to the

    small intestine. Within the liver, smaller tubes, similar to capillaries, drain bile from the cells in

    the liver into larger and larger branches, ending in a tube called the common bile duct. The bile

    duct allows bile, which is made in the liver and stored in the gallbladder, to flow into the small

    intestine. Bile is a liquid that helps to both break down fats found in foods and helps the body

    get rid of waste material filtered out of the bloodstream by the liver.

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    VIDEO OF NORMAL BILE FLOW

    OVERVIEW ON CANCER

    The body is made up of trillions of living cells. Normal body cells grow, divide into new cells,and die in an orderly way. During the early years of a person's life, normal cells divide faster toallow the person to grow. After the person becomes an adult, most cells divide only to replaceworn-out or dying cells or to repair injuries. Cancer begins when cells in a part of the body startto grow out of control. There are many kinds of cancer, but they all start because of out-of-control growth of abnormal cells. Cancer cell growth is different from normal cell growth.Instead of dying, cancer cells continue to grow and form new, abnormal cells. Cancer cells canalso invade (grow into) other tissues, something that normal cells cannot do. Growing out ofcontrol and invading other tissues are what makes a cell a cancer cell. Cells become cancer cellsbecause of damage to DNA. DNA is in every cell and directs all its actions. In a normal cell,when DNA gets damaged the cell either repairs the damage or the cell dies. In cancer cells, thedamaged DNA is not repaired, but the cell doesnt die like it should. Instead, thiscell goes onmaking new cells that the body does not need. These new cells will all have the same damagedDNA as the first cell does.

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    People can inherit damaged DNA, but most DNA damage is caused by mistakes that happenwhile the normal cell is reproducing or by something in our environment. Sometimes the causeof the DNA damage is something obvious, like cigarette smoking. But often no clear cause isfound.

    In most cases the cancer cells form a tumor. Some cancers, like leukemia, rarely formtumors. Instead, these cancer cells involve the blood and blood-forming organs and circulatethrough other tissues where they grow. Cancer cells often travel to other parts of the body,where they begin to grow and form new tumors that replace normal tissue. This process iscalled metastasis. It happens when the cancer cells get into the bloodstream or lymph vesselsof our body. No matter where a cancer may spread, it is always named for the place where itstarted. For example, breast cancer that has pread to the liver is still called breast cancer, notliver cancer. Likewise, prostate cancer that has spread to the bone is metastatic prostatecancer, not bone cancer. Different types of cancer can behave very differently. For example,lung cancer and breast cancer are very different diseases. They grow at different rates andrespond to different treatments. That is why people with cancer need treatment that is aimed attheir particular kind of cancer.

    Not all tumors are cancerous. Tumors that arent cancer are called benign. Benign tumors cancause problemsthey can grow very large and press on healthy organs and tissues. But theycannot grow into (invade) other tissues. Because they cant invade, they also cant spread to

    other parts of the body (metastasize). These tumors are almost never life threatening.

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    v%3D8LhQllh46yI%26feature%3Dshare

    video of a from a healthy cell to cancer cell

    Cholangiocarcinoma is a medical term denoting a form of cancer that is composed of mutatedepithelial cells (or cells showing characteristics of epithelial differentiation) that originate in thebile ducts which drain bile from the liver into the small intestine. Other biliary tract cancersinclude pancreatic cancer, gallbladder cancer, and cancer of the ampulla of Vater.

    Cholangiocarcinomas (CCCs) are malignancies of the biliary duct system that may originate inthe liver and extrahepatic bile ducts, which terminate at the ampulla of Vater CCCs areencountered in 3 geographic regions: intrahepatic, extrahepatic (ie, perihilar), and distalextrahepatic. Perihilar tumors are the most common CCCs, and intrahepatic tumors are theleast common. Perihilar tumors, also called Klatskin tumors (after Klatskin's description of them

    in 1965), occur at the bifurcation of right and left hepatic ducts. Distal extrahepatic tumors arelocated from the upper border of the pancreas to the ampulla. More than 95% of these tumorsare ductal adenocarcinomas; many patients present with unresectable or metastatic disease.

    Cholangiocarcinoma is a relatively rare neoplasm that is classified as an adenocarcinoma (a

    cancer that forms glands or secretes significant amounts of mucins). It has an annual incidence

    rate of 12 cases per 100,000 in the Western world, but rates of cholangiocarcinoma have been

    rising worldwide over the past several decades.

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  • 8/13/2019 cholangiocarcinoma, gallbladder cancer, common bile duct, cy