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Bile Duct Tumor

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Bile Duct Tumor

  1. 1. Bile Duct Tumor
  2. 2. Mechanism of Bile Duct Obstruction
  3. 3. Bile duct tumors <ul><li>Uncommon but serious problem </li></ul><ul><li>Tumor generally are small and difficult to </li></ul><ul><ul><li> visualized with US or CT or MRI </li></ul></ul><ul><li>On average, patients are aged 60-65 yrs </li></ul>
  4. 4. Types of bile duct tumors <ul><li>Distal bile duct tumors </li></ul><ul><li>Proximal bile duct tumor (Klatskin’s tumors) </li></ul>Proximal BD tumor Distal BD tumor
  5. 5. Periampullary Cancer <ul><li>Distal bile duct cancer </li></ul><ul><li>Ampullary cancer </li></ul><ul><li>Pancreatic cancer </li></ul>
  6. 6. Risk factors for bile duct cancer <ul><li>Choledochal cyst </li></ul><ul><li>Polycystic liver </li></ul><ul><li>Parasitic infection: Liver fluke </li></ul><ul><li>Primary sclerosing cholangitis (PSC) </li></ul><ul><li>Ulcerative colitis </li></ul><ul><li>Biliary cirrhosis </li></ul>
  7. 7. Sign and Symptom <ul><li>Progressive jaundice (>90 % ) </li></ul><ul><li>Itchiness </li></ul><ul><li>Abdominal discomfort </li></ul><ul><li>Loss of appetite </li></ul><ul><li>Weight loss </li></ul>
  8. 8. Investigation <ul><li>Blood Test </li></ul><ul><ul><ul><li>LFT: suggestive of cholestasis </li></ul></ul></ul><ul><ul><ul><li>Tumor markers CEA, CA 19-9 </li></ul></ul></ul><ul><li>Imaging studies : </li></ul><ul><ul><ul><li>Ultrasound: shows dilated bile duct, tumors mass may be </li></ul></ul></ul><ul><li>observed in 40% of cases as a hyperechoic lesion. </li></ul><ul><ul><ul><li>CT scan: demonstrated bile duct, tumor mass may be difficult to </li></ul></ul></ul><ul><li>demonstrated, calcification may be obseved. </li></ul><ul><ul><ul><li>MRI: add little to US and CT </li></ul></ul></ul><ul><ul><ul><li>MRCP: providing images of bile duct and </li></ul></ul></ul><ul><ul><ul><li>pancreatic duct like ERCP </li></ul></ul></ul><ul><ul><ul><li>Cholangiography: Percutanious transhpatic cholangiography </li></ul></ul></ul><ul><li>(PTC), Endoscopic retrograde cholangiopancreatography </li></ul><ul><li>(ERCP) </li></ul><ul><li>Diagnostic procedure </li></ul><ul><ul><ul><li>Percutaneous fine needle aspiration </li></ul></ul></ul><ul><li>(Provide definitive Dx in only 30-50% of patients) </li></ul><ul><ul><ul><li>ERCP with biopsy: can detect an abnormality in 90 % of patients </li></ul></ul></ul><ul><ul><ul><li>Intraoperative cholangiography </li></ul></ul></ul>
  9. 9. Treatment <ul><li>Surgery : </li></ul><ul><li>Curative: whipple procedure </li></ul><ul><li>Palliative: bypass surgery, sphincterotomy and/or stent </li></ul><ul><li>placement via ERCP </li></ul><ul><li>Medical : Palliative chemotherapy or RT haven’t been </li></ul><ul><li>proven to be of benefit </li></ul><ul><li> : Symptomatic, supportive </li></ul><ul><li>Prognosis : </li></ul><ul><li>Only 10-20 % of tumors are resectable at presentation, </li></ul><ul><li>if resectable 5 yrs survival is 4-30% </li></ul><ul><li>The anticipated course of most cases are </li></ul><ul><ul><ul><ul><li>local spread </li></ul></ul></ul></ul><ul><ul><ul><ul><li>recurrent biliary obstruction with infection </li></ul></ul></ul></ul><ul><ul><ul><ul><li>death in 6-12 month </li></ul></ul></ul></ul>
  10. 11. Stent placement Palliative treatment

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