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Biliary Tract Cancer

Unlimited Physician MD/DO/PA CME

Stay up to date on the latest medical knowledge with 5925 CME activities. In these online self-assessment activities, you will read our reference articles and test your knowledge with more than 6448.75 hours of CME.


6 Month Unlimited Physician MD/DO/PA CME

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Access to all the Physician MD/DO/PA CME activities in all specialties.
1 Year Unlimited Physician MD/DO/PA CME

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Access to all the Physician MD/DO/PA CME activities in all specialties.

  Biliary Tract Cancer

Credits: 1.00   Post-Assessment Questions:  4

Release Date: 5 Oct 2020
Expiration Date: 31 Jul 2021
Last Reviewed: 31 Jul 2020
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.

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

Author(s) / Contributors Disclosure of Conflicts of Interest

The Campbell University Jerry M. Wallace School of Osteopathic Medicine (CUSOM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they or their immediate family may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by CUSOM for resolution, to ensure fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

CUSOM will identify, review, and resolve all conflicts of interest that faculty, authors, activity directors, planners, managers, peer reviewers, or relevant staff disclose prior to an educational activity being delivered to learners. Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation. Disclosure information for authors, editors, planners, peer reviewers, and/or relevant staff is provided with this activity.

Contributors

Hover over the contributor names to see details and disclosures of any financial relationships or relationships they or their spouse/life partner have with commercial interests related to the content of this continuing education activity.

Authors: Zarlakhta Zamani
Editors: Saira Fatima
Editors-In-Chief: Jon ParhamJon SivoravongChristine Burkhardt
Chief Medical Reviewer: Shiva Kumar Mukkamalla
Nurse Planner/Reviewer/Editor: Lisa Haddad
Pharmacy Planner/Reviewer/Editor: Mark Pellegrini
Physician Planner/Reviewer/Editor: Scott Dulebohn

Continuing Education Accreditation Information


The Campbell University Jerry M. Wallace School of Osteopathic Medicine (CUSOM) is accredited by the American Osteopathic Association to provide osteopathic continuing medical education for physicians. CUSOM designates this enduring material for a maximum of 1.00 AOA Category 1 B Credits and will report CME credits commensurate with the extent of the physician's participation in the activity.

 

Cancellation Policy: Cancellations must be received in writing and a money back guarantee is provided if not completely satisfied.

  • StatPearls and CUSOM reserve the right to cancel any course due to unforeseen circumstances. StatPearls and CUSOM will not be responsible for other expenses incurred by the participant in the unlikely event that the program is canceled.

Equal Opportunity

  • StatPearls and CUSOM are Equal Opportunity / Affirmative Action / Equal Access Institutions. 

Medium or Media Used:

  • Computer Requirements:  Internet Access
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Instructions for Credit

  1. Register for the activity and create a StatPearls login.     
  2. Review the required accreditation information:  Target audience, learning objectives and disclosure information.
  3. Complete the entire self-study activity.
  4. Complete the post-test assessments.
  5. Successfully pass the post-test with a minimum score of 100%.
  6. Complete the evaluation form.
  7. Obtain a certificate.

StatPearls and CUSOM adheres to AOA Standards regarding commercial support of continuing medical education. It is the policy of StatPearls and Campbell that the faculty and planning committee disclose real or apparent conflicts of interest relating to the topics of this educational activity, that relevant conflict(s) of interest are resolved and also that authors and editors will disclose any unlabeled/unapproved use of drug(s) or device(s) during their presentation. Detailed disclosure will be made prior to starting the activity.

The information provided at this CME/CE activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

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This course is intended for osteopathic physicians who wish to earn AOA CME credit. Take this version of the course to ensure you receive appropriate credit.

Media Usage Rights

The contributors and editors of StatPearls have attested that all associated media (images and video) have been legally cleared for use with this activity.  All copyrights are reserved.

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