Biliary Tract Cancer


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Expiration Date

31 Dec 2023

Last Reviewed

1 Jan 2021

Estimated Time To Finish

60 Minutes

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Activity Description

Biliary tract cancer consists of tumors that arise from epithelial cells lining the biliary tract, which consists of the intrahepatic bile duct, extrahepatic bile duct, gall bladder, and ampulla of Vater. Gallbladder cancer is the most common cancer of the biliary tract and the third most common cancer of the gastrointestinal tract. The common routes of tumor spreading are vascular, lymphatic, intraperitoneal, neural, and intraductal. The common sites of metastasis are liver, lymph nodes, and adjacent organs. This activity reviews the evaluation and treatment of biliary tract cancer and highlights the role of the interprofessional team in evaluating and treating patients with this condition.

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Target Audience

This activity has been designed to meet the educational needs of physicians.

Learning Objectives

At the conclusion of this activity, the learner will be better able to:

  • Chronic inflammatory conditions predispose the biliary tract epithelium to modify under stress and undergo transformation that give rise to the cancer of the biliary tract. The most established chronic inflammatory condition associated with biliary tract cancer is primary sclerosing cholangitis (PSC), which is associated with chronic inflammatory bowel disease, particularly ulcerative colitis. Besides primary sclerosing cholangitis, other conditions that carries a high risk for the development of cholangiocarcinoma by causing chronic inflammation and cholestasis are colonization with liver flukes such as Clonorchis sinensis (endemic in southern China, Hong Kong, and Korea) or Opisthorchis viverrini (endemic in north-eastern Thailand, western Malaysia, and Laos), hepatolithiasis, chronic infection withand some congenital biliary tract malformations (e.g. caroli‚Äôs disease, choledochal cysts) are also associated with the risk of developing cholangiocarcinoma.
  • Keeping in sight the clinical manifestations, it is essential to carry out a thorough physical examination, blood tests and imaging to look for the cause of the sign and symptoms. Diagnostic evaluation is dependent both on laboratory and imaging tests, which includes: Blood Tests Serum levels of certain enzymes and proteins that help monitor the liver disease or damage otherwise known as liver function tests which includes; Aspartate aminotransferase (AST), alanine aminotransferase (AST), bilirubin, as well as biliary tract excreted products as bile salts, gamma glutamyl transpeptidase (GGT) and alkaline phosphatase (ALP). Imaging Abnormal liver function tests are not specific to biliary tract carcinoma as it is present in a wide range of diseases involving the liver. Therefore, imaging plays a vital role in the diagnosis, staging and management of the patients having cholestatic pattern on the initial laboratory tests. Ultrasonography and CT scan remains the initial imaging modality performed in patients with symptoms of biliary tract obstruction to determine the anatomy and location of the tumor. Direct bile duct visualization is often necessary, which is carried out with an invasive procedure called endoscopic retrograde cholangiopancreatography (ERCP) or a non-invasive magnetic resonance cholangiopancreatography (MRCP). Endoscopic ultrasonography (USG) can also be performed during endoscopic retrograde cholangiopancreatography. Endoscopic retrograde cholangiopancreatography (ERCP) allows both diagnostic and therapeutic interventions like taking of a biopsy sample and stent placement, respectively. For tissue diagnosis, a biopsy sample is taken while performing endoscopic ultrasonography via fine-needle aspiration, or a percutaneous biopsy could be performed.
  • Surgery remains the only curative treatment of localized biliary tract cancer. Advanced tumor stage at the time of diagnosis, including metastatic and recurrent bile duct cancers, or in patients who do not fit as surgical candidate, the following treatment options are considered. Chemotherapy Palliative therapy Immunotherapy Molecular targeted therapy
  • An interprofessional approach is needed to deal with patients with biliary tract cancer, which includes a team of oncologists, radiologists, gastroenterologists, and experienced surgeons to manage such challenging tumors. Tumors that are not advanced can be treated with surgical resection. For unresectable tumors, multiple treatment approaches are available such as chemotherapy, radiation therapy, palliative treatment, targeted molecular therapy, and immunotherapy. Recent clinical studies and data suggests promising results of immunotherapy and targeted molecular therapy.

Author(s) / Contributors Disclosure of Conflicts of Interest

Each author, editor, faculty and planning committee member have completed a disclosure form indicating that neither they nor their spouse/partner has a financial interest/arrangement or affiliation that could be perceived as a real or apparent conflict of interest related to the content of this activity.

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This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Quillen College of Medicine, East Tennessee State University, and StatPearls, LLC. The Quillen College of Medicine, East Tennessee State University is accredited by the ACCME to provide continuing medical education for physicians.

Quillen College of Medicine, East Tennessee State University designates this activity for a maximum of 1.00 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This activity is reported to the following Maintenance of Certification (MOC) boards:
American Board of Internal Medicine
  • Adolescent Medicine
  • Internal Medicine
  • Medical Oncology
  • Gastroenterology
American Board of Pathology
  • GI (incl. Liver, Pancreas, Bilary)
American Board of Pediatrics
  • Adolescent Medicine
  • General Pediatrics
  • Pediatric Gastroenterology
American Board of Surgery
  • Complex General Surgical Oncology
  • General Surgery

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    Deborah Z. on 7/9/2021

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