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Bile Duct Tumor
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Bile Duct Tumor

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Transcript

  • 1. Bile Duct Tumor
  • 2. Mechanism of Bile Duct Obstruction
  • 3. 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
  • 4. Types of bile duct tumors
    • Distal bile duct tumors
    • Proximal bile duct tumor (Klatskin’s 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 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
  • 10.  
  • 11. Stent placement Palliative treatment