10/12/2015

CholangiocarcinomaFollowup:FurtherOutpatientCare,Complications,Prognosis

CholangiocarcinomaFollowup
Author:PeterEDarwin,MDChiefEditor:JulesEHarris,MD,FACP,FRCPCmore...
Updated:Mar26,2015

FurtherOutpatientCare
Mostpatientswithcholangiocarcinomarequirefollowupcareforacuteandlate
adverseeffectsoftherapy.Aggressivefollowupcarealsoisnecessarytotreat
symptomsfromtumorrecurrenceandpersistence.Patientswiththebestprognosis
maybeseenevery23monthswithperiodiclaboratoryandimagingstudies(eg,CT
scan).
Patientstreatedpalliativelymayenterhospiceprogramsrapidly,asmediansurvival
durationisonly28months.

Complications
Complicationsincludethefollowing:
Infectionofthebiliarytree(ie,cholangitis)mayresultfrom
cholangiocarcinomaandsubsequentobstructionoftheduct.
Between10and20%ofpatientswithcholangiocarcinomadevelopcirrhosis.
Thismaybesecondarybiliarycirrhosisresultingfromneoplasticobstruction
ofthebileductsorrelatedtounderlyingfibrosisfromprimarysclerosing
cholangitis.
Othercomplicationsareusuallytheresultofdiagnosticandtherapeutic
procedures.

Prognosis
Patientswithperihilartumorsthatarecompletelyresectedmayachievelongterm
survival.Prognosisispoorestforpatientswithintrahepatictumors.
Patientswithdistalextrahepatictumorsmayhavethebesthopeforsurvivalif
tumorsareexcisedcompletelytumorsatthissitearethemostlikelytobe
resectable.Thesepatientsmayexperiencea5yearsurvivalrateashighas40%.
Themediansurvivaldurationinpatientswhoundergoresectionandpostoperative
chemoradiationmaybeashighas1727.5months.AstudybyPolistinaetalfound
thatchemoradiationgivenbystereotacticbodyradiotherapyplusgemcitabineoffers
highlocalcontrolratesandisapromisingtreatment. [26]
Anintermediateprognosis(ie,mediansurvivaldurationof717mo)isachievedfor
patientswhoareunabletoundergoresectionbutcantolerateadjuvant
chemoradiationorpossiblyphotodynamictherapy.
Thepoorestprognosisisforthepatientwithunresectabledisease,withorwithout
overtmetastaticdisease,whocantolerateonlypalliativestentplacement.
AstudybyGhafoorietalfoundthatpatientswithlocallyadvancedextrahepatic
cholangiocarcinomahavepoorsurvivalwithrarelongtermsurvival.Mostpatients
treatedwithexternalbeamradiationtherapy(EBRT)hadlocalcontrolatthetimeof
death,whichsuggeststhatsymptomsrelatedtothelocaltumoreffectmaybe
controlledusingradiationtherapy.Theauthorsconcludedthatnovelapproachesare
indicatedinthetherapyforthiscondition. [27]

ContributorInformationandDisclosures
Author
PeterEDarwin,MDProfessorofMedicine,DirectorofGIEndoscopy,DepartmentofMedicine,Divisionof
Gastroenterology,UniversityofMarylandSchoolofMedicine
PeterEDarwin,MDisamemberofthefollowingmedicalsocieties:AmericanSocietyforGastrointestinal
Endoscopy
Disclosure:Nothingtodisclose.
Coauthor(s)
AndrewScottKennedy,MDPhysicianinChief,RadiationOncology
AndrewScottKennedy,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
AssociationforCancerResearch,AmericanSocietyforRadiationOncology,RadiologicalSocietyofNorth
America,AmericasHepatoPancreatoBiliaryAssociation,AmericanSocietyofClinicalOncology
Disclosure:Nothingtodisclose.
JenniferLynnBonheur,MDAttendingPhysician,DivisionofGastroenterology,LenoxHillHospital
JenniferLynnBonheur,MDisamemberofthefollowingmedicalsocieties:AmericanGastroenterological
Association,AmericanSocietyforGastrointestinalEndoscopy,NewYorkSocietyforGastrointestinalEndoscopy,
NewYorkAcademyofSciences,SigmaXi
Disclosure:Nothingtodisclose.
SpecialtyEditorBoard
FranciscoTalavera,PharmD,PhDAdjunctAssistantProfessor,UniversityofNebraskaMedicalCenterCollege
ofPharmacyEditorinChief,MedscapeDrugReference

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Disclosure:ReceivedsalaryfromMedscapeforemployment.for:Medscape.
BenjaminMovsas,MD
BenjaminMovsas,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofRadiology,American
RadiumSociety,AmericanSocietyforRadiationOncology
Disclosure:Nothingtodisclose.
ChiefEditor
JulesEHarris,MD,FACP,FRCPCClinicalProfessorofMedicine,SectionofHematology/Oncology,University
ofArizonaCollegeofMedicine,ArizonaCancerCenter
JulesEHarris,MD,FACP,FRCPCisamemberofthefollowingmedicalsocieties:AmericanAssociationforthe
AdvancementofScience,AmericanSocietyofHematology,CentralSocietyforClinicalandTranslational
Research,AmericanSocietyofClinicalOncology
Disclosure:Nothingtodisclose.

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