Cholangiocarcinoma Follow-up

  • Author: Peter E Darwin, MD; Chief Editor: Jules E Harris, MD   more...
 
Updated: Feb 23, 2012
 

Further Outpatient Care

  • Most patients with cholangiocarcinoma require follow-up care for acute and late adverse effects of therapy. Aggressive follow-up care also is necessary to treat symptoms from tumor recurrence and persistence. Patients with the best prognosis may be seen every 2-3 months with periodic laboratory and imaging studies (eg, CT scan).
  • Patients treated palliatively may enter hospice programs rapidly, as median survival duration is only 2-8 months.
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Complications

  • Infection of the biliary tree (ie, cholangitis) may result from cholangiocarcinoma and subsequent obstruction of the duct.
  • Between 10 and 20% of patients with cholangiocarcinoma develop cirrhosis. This may be secondary biliary cirrhosis resulting from neoplastic obstruction of the bile ducts or related to underlying fibrosis from primary sclerosing cholangitis.
  • Other complications are usually the result of diagnostic and therapeutic procedures.
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Prognosis

  • Patients with perihilar tumors that are completely resected may achieve long-term survival. Prognosis is poorest for patients with intrahepatic tumors.
  • Patients with distal extrahepatic tumors may have the best hope for survival if tumors are excised completely; tumors at this site are the most likely to be resectable. These patients may experience a 5-year survival rate as high as 40%. The median survival duration in patients who undergo resection and postoperative chemoradiation may be as high as 17-27.5 months. A study by Polistina et al found that chemoradiation given by stereotactic body radiotherapy plus gemcitabine offers high local control rates and is a promising treatment.[23]
  • An intermediate prognosis (ie, median survival duration of 7-17 mo) is achieved for patients who are unable to undergo resection but can tolerate adjuvant chemoradiation or possibly photodynamic therapy.
  • The poorest prognosis is for the patient with unresectable disease, with or without overt metastatic disease, who can tolerate only palliative stent placement.
  • A study by Ghafoori et al found that patients with locally advanced extrahepatic cholangiocarcinoma have poor survival with rare long-term survival. Most patients treated with external beam radiation therapy (EBRT) had local control at the time of death, which suggests that symptoms related to the local tumor effect may be controlled using radiation therapy. The authors concluded that novel approaches are indicated in the therapy for this condition.[24]
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Contributor Information and Disclosures
Author

Peter E Darwin, MD  Associate Professor, Director of GI Endoscopy, Department of Medicine, Division of Gastroenterology, University of Maryland School of Medicine

Peter E Darwin, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, and American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Coauthor(s)

Andrew Scott Kennedy, MD  Co-Medical Director, Wake Radiology Oncology

Andrew Scott Kennedy, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American Hepato-Pancreato-Biliary Association, American Society for Therapeutic Radiology and Oncology, American Society of Clinical Oncology, and Radiological Society of North America

Disclosure: Nothing to disclose.

Jennifer Lynn Bonheur, MD  Attending Physician, Division of Gastroenterology, Lenox Hill Hospital

Jennifer Lynn Bonheur, MD is a member of the following medical societies: American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, New York Academy of Sciences, New York Society for Gastrointestinal Endoscopy, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael Perry, MD, MS, MACP  Nellie B Smith Chair of Oncology Emeritus, Director, Division of Hematology and Medical Oncology, Deputy Director, Ellis Fischel Cancer Center, University of Missouri-Columbia School of Medicine

Michael Perry, MD, MS, MACP is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society of Clinical Oncology, American Society of Hematology, International Association for the Study of Lung Cancer, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Benjamin Movsas, MD  Vice-Chairman, Department of Radiation Oncology, Fox Chase Cancer Center

Benjamin Movsas, MD is a member of the following medical societies: American College of Radiology, American Radium Society, and American Society for Therapeutic Radiology and Oncology

Disclosure: Nothing to disclose.

Rajalaxmi McKenna, MD, FACP  Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems

Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD  Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research

Disclosure: GlobeImmune Salary Consulting

References

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Bismuth classification for perihilar cholangiocarcinoma. Shaded areas represent tumor location.
Tight stricture of a common hepatic duct in a patient presenting with jaundice. Cytologic studies confirmed cholangiocarcinoma.
Three-dimensional treatment planning uses CT scan slices to reconstruct the patient as a volume. Shown here is the display for planning external-beam radiotherapy to the cholangiocarcinoma (green structure). A biliary catheter (red tube) runs through the tumor volume and was used to deliver brachytherapy, which was given in addition to external-beam radiotherapy. Such technology has assisted greatly in the delivery of high doses to the tumor, while sparing vital normal structures, such as the kidney and spinal cord.
 
 
 
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