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Bile Duct Tumor
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Mechanism of BileDuct Obstruction
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Bile duct tumors
Uncommon but serious problem
Tumor generally are small and difficult to visualized with US or CT or MRI
On average, patients are aged 60-65 yrs
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Types of bile duct tumors
Distal bile duct tumors
Proximal bile duct tumor (Klatskin’s tumors)
ProximalBD tumor
Distal BD tumor
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Periampullary Cancer
Distal bile duct cancer
Ampullary cancer
Pancreatic cancer
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Risk factors for bile duct cancer
Choledochal cyst
Polycystic liver
Parasitic infection: Liver fluke
Primary sclerosing cholangitis (PSC)
Ulcerative colitis
Biliary cirrhosis
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Sign and Symptom
Progressive jaundice (>90%)
Itchiness
Abdominal discomfort
Loss of appetite
Weight loss
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InvestigationBlood 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
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Treatment
Surgery: Curative: whipple procedurePalliative: bypass surgery, sphincterotomy and/or stent
placement via ERCPMedical: Palliative chemotherapy or RT haven’t 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
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Stent placement
Palliative treatment
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