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home - Biliary - Biliary Cancers - Cholangiocarcinoma Treatment Written by Dr Sebastian Zeki
Knowledge


Knows the epidemiology pathology and clinical presentation of bile
duct tumours

Can recognise the presentation of biliary tumours arising de novo or
in the context of PSC Can plan programme of investigations
including detailed staging

Understands treatment options including surgery chemotherapy and
endoscopic management

Skills
Aware of the treatment options including biliary drainage
chemotherapy radiotherapy photodynamic therapy or surgery

Understands rationale for selection of particular therapy in individual
patients

Awareness of the diagnostic modalities including CT MRI scanning
brush cytology intra ductal cholangioscopy and biopsy

Behaviours
Understands importance of multidisciplinary team of oncologist
surgeon radiologist histopathologist in decision making

Discusses cases with the specialist MDT

Cholangiocarcinoma Treatment

Resectable Resection+/- ablation Metastatic Unresectable 5-FU-based regimen IntrahepaticCholangiocarcinoma Consider imagingevery 6mofor2y Microscopic margins or Residual localdisease Considerreresection/ Ablation or Rchemotherapy with5-FU-based regimenor gemcitabine SurgicalProceduresforResectableDisease ProximalThird MidThird DistalThird :Hilarresection+lymphadenectomy+enblocliver resection.Caudateresectionstronglyencouraged. :Majorbileductexcisionwithlymphadenectomy. Recommendfrozensectionassessmentofbileductmargins. :Pancreaticoduodenectomywithlymphadenectomy. Unresectable/ Metastatic:Palliative therapy 5-FU-based chemotherapy/RT (brachytherapy or externalbeam)- if no mets and unresectable only or Chemotherapywith5-FU-based regimen or gemcitabine Consider5-FU–based chemotherapy/RT (brachytherapyorexternalbeam) Observe or 5-FU–basedchemotherapy/RT Chemoradiotherapy (5-FU-based regimenorgemcitabine) or gemcitabine Treatment of Cholangiocarcinoma Microscopic margins Residual localdisease Negative margins ExtrahepaticCholangiocarcinoma Resectable:Resect Negative margins Written by Dr Sebastian Zeki

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