Cellular MR Imaging of the Liver Using Contrast Agents
Michel M. J. Modo, Jeff W. M. Bulte in Molecular and Cellular MR Imaging, 2007
Primary malignant tumors of liver cells are called hepatocellular carcinoma (HCC). HCC arises in cirrhotic livers and patients with hepatitis. A malignant transformation of the hepatocytes follows the stages of mildly to severely dysplastic nodules, ending up with HCC. HCC is histopathologically graded as moderately and poorly differentiated tumors according to their non-neoplastic hepatocellular content. Poor differentiation of HCC is associated with increased arterial neovascularization of the lesion. Cholangiocarcinoma is the neoplasia of the biliary tree, can arise from the main intrahepatic bile ducts, or can have peropheric intrahepatic location. Cholangiocarcinomas have poor arterial vascularization and are known as hypovascular tumors. Secondary tumors of the liver are metastatic lesions to the liver.13–16
Gastrointestinal cancer
Michael JG Farthing, Anne B Ballinger in Drug Therapy for Gastrointestinal and Liver Diseases, 2019
Cancers of the biliary tract, including carcinoma of the gall bladder and cholangiocarcinoma, are rare, and few clinical trials have addressed their management. Patients frequently present with advanced disease that is not amenable to surgical resection, and the prognosis is poor, with a median survival of less than 6 months. Palliative chemotherapy may have a role, as suggested by a trial comparing 5-fluorouracil, leucovorin and etoposide with best supportive care alone. This demonstrated improved survival (6 versus 2.5 months; p < 0.01) and quality of life in the chemotherapy arm.40 This trial included both biliary and pancreatic cancer patients (a feature of many studies of this disease) but the benefits of treatment were seen in both tumour types. 5-Fluorouracil is the most commonly used single agent, with response rates of about 10–20%. Combination of cisplatin and 5-fluorouracil increased the response rate to 32%,64 and further addition of epirubicin (the ECF regimen) produced a 40% response rate and a 40% 1-year survival.65 An interesting agent in this disease is alpha-interferon. A regimen combining a 5-day infusion of 5-fluorouracil with alpha-interferon on Days 1, 3 and 5, repeated every 2 weeks produced a response rate of 39%, and a median survival of 1 year among 19 patients.66
HPB Surgery
Tjun Tang, Elizabeth O'Riordan, Stewart Walsh in Cracking the Intercollegiate General Surgery FRCS Viva, 2020
A 75-year-old woman with intractable itch for several months now complains of jaundice for a few days. She is otherwise well. How would you approach this problem?This is a woman with painless jaundice in the background of intractable itch suggestive of obstructive jaundice. The most likely differentials would be tumours that can obstruct the main biliary tree including pancreatic head carcinoma, ampullary/periampullary tumours and extrahepatic cholangiocarcinoma.A simple US of the biliary tree will help determine the possible level of obstruction and help define the appropriate next investigation. If both intrahepatic and extrahepatic biliary dilatation is seen on US, the lesion is expected to be in the distal CBD or head of pancreas and a follow-on CT of the pancreas or an MRCP will be an appropriate next step. If only intrahepatic biliary dilatation is seen and the extrahepatic ducts are not dilated, a hilar cholangiocarcinoma needs to be excluded and in this setting, an MRCP would be the correct investigation.
Clinical insights and prognostic factors from an advanced biliary tract cancer case series: a real-world analysis
Published in Journal of Chemotherapy, 2022
Roberto Filippi, Francesco Leone, Lorenzo Fornaro, Giuseppe Aprile, Andrea Casadei-Gardini, Nicola Silvestris, Andrea Palloni, Maria Antonietta Satolli, Mario Scartozzi, Marco Russano, Stefania Eufemia Lutrino, Pasquale Lombardi, Giorgio Frega, Silvio Ken Garattini, Caterina Vivaldi, Rosella Spadi, Orsi Giulia, Elisabetta Fenocchio, Oronzo Brunetti, Massimo Aglietta, Giovanni Brandi
Biliary tract cancer (BTC) comprises a spectrum of epithelial malignancies arising from the biliary tree, with varying composition (intrahepatic cholangiocarcinoma [ICC]; distal and proximal extrahepatic cholangiocarcinoma [dECC, pECC]; gallbladder cancer [GC]) according to the geographic region [1]. Ampullary cancer (AC) is often regarded as an additional primary site of BTC [2–4]. Southern Europe has a higher incidence of BTC than Northern European countries [5]. Italy, where BTC accounts for 1% of new cancer diagnoses, lies among the intermediate-incidence countries [1, 6]. Due to the tendency to relapse after resection, and the aggressiveness and resistance to chemotherapy (CT) in the advanced setting (aBTC), prognosis of these patients (pts) is dismal [1, 7–10]. In 2010, the cisplatin-gemcitabine (gem) doublet (GemCis) emerged as the standard first-line CT (CT1) in the BT-22 and ABC-02 trials [11, 12]. In contrast, only recently data from the ABC-06 trial supported mFOLFOX as a candidate for standard second-line CT (CT2) [13]. Targeted and immunologic therapies do not yet represent a standard treatment option in BTC pts [14–16].
Emerging treatment strategies in hepatobiliary cancer
Published in Expert Review of Anticancer Therapy, 2023
Deniz Can Guven, Hasan Cagri Yildirim, Elvin Chalabiyev, Fatih Kus, Feride Yilmaz, Serkan Yasar, Arif Akyildiz, Burak Yasin Aktas, Suayib Yalcin, Omer Dizdar
Cholangiocarcinoma arises from the biliary tract epithelium. Primary sclerosing cholangitis, biliary stone disease, and biliary tract infections are recognized risk factors for cholangiocarcinoma [7]. According to their location, they can be categorized as intrahepatic or extrahepatic. The most prevalent type is extrahepatic. Extrahepatic tumors are further classified as hilar (pCCA) (sometimes referred to as Klatskin tumors), and distal extrahepatic cholangiocarcinoma (dCCA) [8,9]. In contrast to GBC, the eCCA presents with obstructive jaundice earlier in the disease course [6], while iCCA is generally diagnosed very late due to nonspecific symptoms. Patients with iCCA have higher rates of FGFR fusions and IDH-1 mutations, while HER2/3 amplifications are more frequent in eCCAs [6].
What are the key challenges in the pharmacological management of cholangiocarcinoma?
Published in Expert Opinion on Pharmacotherapy, 2022
Matthew Ledenko, Tushar Patel
Cholangiocarcinomas are rare cancers that originate from within the biliary tract. There are three main types of cholangiocarcinoma defined by their location within the biliary tract, intrahepatic, perihilar, or distal [1]. These cancers are characterized by low overall survival rates and contribute to ~3% of all cancer-related mortality in the United States. For early stage disease, surgical resection can be curative. However, the tumors may remain asymptomatic until diagnosis at an advanced stage when curative surgery with their removal or with an R0 resection may not be feasible. While locally directed approaches such as photodynamic therapy, radiation, or ablative therapies have been used, their success rates have been modest, and their benefit for advanced disease have been limited. This highlights the dire need for earlier timely diagnosis as well as for an expanded armamentarium of more effective systemic therapies for advanced or metastatic disease. Until recently, pharmacotherapeutic options for systemic therapy were limited to chemotherapy. However, several new therapies targeting specific molecular pathways have now been approved for cholangiocarcinoma. The advent of these and other options dramatically alters the treatment landscape and management approach to these cancers.