All types of cancerous growth in the biliary duct are termed as cholangiocarcinoma. History Altemei, the great surgeon, and clinical educator first described the cancerous growth at the bifurcated junction of the biliary duct in Etiology The etiology of the Klatskin Tumor is not evident based. Multiple pathological conditions, which cause acute or chronic ailments of the biliary tract may have the influence to develop a malignant growth.
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All types of cancerous growth in the biliary duct are termed as cholangiocarcinoma. History Altemei, the great surgeon, and clinical educator first described the cancerous growth at the bifurcated junction of the biliary duct in Etiology The etiology of the Klatskin Tumor is not evident based. Multiple pathological conditions, which cause acute or chronic ailments of the biliary tract may have the influence to develop a malignant growth. The idiopathic cause of the development of primary sclerosing cholangitis has a direct association of Klatskin Tumor.
Reflux of pancreatic secretions An abnormal pancreatico-biliary duct junction, which possibly responsible for back flowing reflux of pancreatic secretions into the bile duct and may have an association with Klatskin tumor.
Parasitic infection Opisthorchis viverrini and Clonorchis sinensis are chronic biliary tract parasitic infection and considered as a risk factor for the development of Klatskin tumor. Stone formation in the bile duct Choledocholithiasis and hepatolithiasis are the conditions which influence to altering the malignant changes.
Incidence Rate Growing industrialization and other environmental factors may responsible for an annual increasing incidence rate of Klatskin tumor. The predominance of this disease mainly occur after six decades and that can extend up to eight decades of life. Sign and Symptoms At the initial stage, Klatskin tumor is asymptomatic.
But progression of the malignancy cause following symptoms: Abdominal pain General malaise Itchy skin pruritus Jaundice is in advance stage. After the onset of jaundice, the included symptoms are yellowish skin color, stools color changed to clay in color, as because of bile juice is responsible for normal stool coloration, dark yellow colored urine.
The metastasis of the Klatskin tumor can extend up to localized lymph nodes and from there malignancy can spread to pancreatic head, common hepatic artery, and portal vein6. Diagnosis The following are the different diagnostic tools use for Klatskin tumor diagnosis. Laboratory tests Laboratory test results provide following abnormalities, which indicates Klatskin tumor presence Considerable tumor marker for Klatskin tumor is Serum carbohydrate antigen CA This marker is glycoprotein in nature and found to be high in blood serum of the affected individual.
Elevated levels of conjugated bilirubin, alkaline phosphate ALP and gamma-glutamyl transpeptidase GGT are also observed7. Ultrasound Ultrasound examination of the whole abdomen can provide some specific features of Klatskin tumor, which provides the following findings Intrahepatic biliary ducts images showed dilation, though similar findings are not present in the extrahepatic duct Right and left hepatic ducts are not united Tiny, solid lumps are present at the hepatic hilus and those may locally spread to the liver.
It is considered that if no abnormality finds in the pancreas, as well as no tumor growth also present in the pancreatic region then further high degree accurate diagnosis is required for the Klatskin tumor8. Biopsy Endoscopic retrograde cholangiopancreatography ERCP is used to conduct biopsy for a suspicious mass present in the bile duct7. CT Scan Helical computerized computed tomography CT with contrast enhancement imaging tool is used for envisaging the spreading of the metastasis6.
Treatment and Management The main aims of the treatment for Klatskin Tumor are biliary blockage breakage, resection of the tumor. Early stage diagnosis has some options to provide curative treatment for the Klatskin Tumor, which include chemotherapy and radiotherapy, surgical resection of the tumor.
But the success of this treatment maximum depends upon the stage of the disease and treatment acceptance of the patient, as all these treatments have several side effects. But these treatments methods are not much effective in an advanced stage of Klatskin tumor when metastasis spread into a wide area.
Surgical resection Surgical resection is very carefully conducted so that negative margin of the tumor left over. Usually, liver surgical resection is conducted with caudate lobectomy and this process helps to provide the maximum prospect of negative resection margins. Biliary stents Biliary stents that may make with plastic and metal can place during palliative treatment.
Percutaneous transhepatic catheters Percutaneous transhepatic catheters supply the greatest access for palliation of terminal Klatskin tumors. If resection is not possible then combination therapy of gemcitabin and cisplatin has been acknowledged as a standard Therapy6. Survival rate The survival rate of Klatskin Tumor is poorer as these tumors are only diagnosed at an advanced stage. Management strategies in resection for hilar cholangiocarcinoma. Ann Surg.
Hilar cholangiocarcinoma patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system. Association of preoperative biliary stenting with increased postoperative infectious complications in proximal cholangiocarcinoma. Arch Surg. Treatment of hilar cholangiocarcinoma Klatskin tumors with hepatic resection or transplantation. J Am Coll Surg.
A Closer Look at Klatskin Tumor Treatment Options
Cause[ edit ] The cause of cholangiocarcinoma has not been defined. A number of pathologic conditions, however, resulting in either acute or chronic biliary tract epithelial injury may predispose to malignant change. These conditions appear to be related to an anomalous pancreatico-biliary duct junction and, perhaps, are related to the reflux of pancreatic secretions into the bile duct. Chronic biliary tract parasitic infection, seen commonly in Southeast Asia due to Clonorchis sinensis and Opisthorchis viverrini , has also been identified as a risk factor. Further, industrial exposure to asbestos and nitrosamines , and the use of the radiologic contrast agent, Thorotrast thorium dioxide , are considered to be risk factors for the development of cholangiocarcinoma. Diagnosis[ edit ] Levels of the tumor markers carbohydrate antigen CA , carcinoembryonic antigen CEA and CA are abnormally high in the bloodstreams of patients with intrahepatic cholangiocarcinoma and Klatskin tumor.
Tumor de Klatskin
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