Cholangiocarcinoma, CCA


1.Intrahepatic- Proximal to the bifurcation of the right and left hepatic ducts, 10%


a)Perihilar- Confluence+proximal to insertion of cystic duct into CBD, 50%

b)Distal extrahepatic- Distal to insertion of cystic duct into CBD to ampulla of Vater(not included), 40%→ pancreaticojejunostomy, PD 

Bismuth-Corlette classification for perihilar tumors

Type Ibelow confluenceen bloc resection + Roux-en-Y hepaticojejunostomy
Type IIinvolve confluence
Type IIIIIIAinvolved right hepatic ducten bloc resection + Roux-en-Y hepaticojejunostomy + right/left hepatectomy
IIIBinvolve left hepatic duct
Type IV involve both hepatic ducts
  • Klatskin tumor– Cholangiocarcinoma involving bifurcation

Risk factor- PSC, choledochal cyst, recurrent pyogenic cholangitis, Chronic liver disease(HCV>HBV), Clonorchis and Opisthorchis, HNPCC, multiple biliary papillomatosis, DM, obesity, metabolic syndrome, cystic fibrosis, HIV?, H.pylori?

Presentation- Obstructive jaundice, abdominal pain, weight loss, fever

Lab- Elevated CA-199

Histology- Adenocarcinoma(90%)> squamous cell carcinoma, keratin

Tumor marker- CA-125, CA 19-9, IL-6

Echo- CBD > 7mm


1.Sclerosing- Most common, intense desmoplastic reaction

2.Nodular- constricting annular lesion of the bile duct

3.Papillary-  bulky masses in the common bile duct lumen, rarest

Published by Steve Johnson

I am a doctor who like to organise knowledges and share ideas with others. As a doctor, a lot of knowledges influx everyday and need some patient to organise and absorb. Here was my notes to share with you and hope to save your time to know it.

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