Bile duct cancer

Neoplasms (e.g., hepatoma, cholangiocarcinoma, hepatoblastoma, and bile duct cancer)... 

Tanno, S., Yanagawa, N A., Habiro, K. et al. 2004. Serine/threonine kinase AKT is frequently activated in human bile duct cancer and is associated with increased radioresistance. Cancer Res 64 3486-3490. 

Gallbladder carcinoma is diagnosed approx 5000 times a year in the United States, making it the most common biliary tract cancer and fifth most common gastrointestinal tract cancer. Also, approx 4500 cases of bile duct cancer occur each year in the United States. Women are more commonly afflicted than men, with a female-to-male ratio of 2.7 1.0. The median age at presentation of gallbladder cancer is 73 yr. In addition, an incidence five to six times that in the general population is seen in southwestern Native Americans, Mexicans, Hispanics, and Alaskans. 

Bile duct malignancy is diagnosed approx 3000 times a year in the United States and is found equally in men and women. Extrahepatic bile duct cancers occur primarily in older individuals, with a median age at diagnosis of 70 yr. 

The risk of gallbladder cancer is higher in patients having cholelithiasis or a calcified gallbladder and typhoid carriers, while ulcerative colitis is a clear risk factor for bile duct cancer. Patients having ulcerative colitis have an incidence of bile duct cancer that is 9-21 times higher than that in the general population. 

Primary sclerosing cholangitis, congenital anomalies of the pancreaticobiliary tree, and parasitic infections are also associated with bile duct cancer. 

The rate of resectability is only 15-20% for proximal bile duct carcinomas but up to 70% for distal lesions. In addition, there is little benefit to preoperative decompression of the biliary tree in patients having obstructive jaundice (65,66). However, this procedure is frequently practiced. For proximal cancers, local excision is often possible. In particular, hepatic resection is indicated for upper bile duct cancers with quadrate lobe invasion or unilateral intrahepatic ductal or vascular involvement, and distal and midductal lesions may require pancreatoduodenectomy. Also, biliary-enteric continuity... 

The role of preoperative therapy for resectable disease remains ill defined. Local recurrence after curative resection of gallbladder cancer can be as high as 86% (70). Resected bile duct cancers have a rate of local recurrence of 25-40% (71). 

Update of Gustavsson et al. (1986) study nine additional years of followup. Analyses for Incidence of liver and bile duct cancer were conducted for the entire cohort or stratified by exposure status (low versus high exposure) or time since first exposure (>10 or >20 years). SIR=256 (95% CI=31-926) for the entire cohort. One each of cholangiocellular cancer and adenocarcinoma were reported. 

Argani P, Shaukat A, Kaushal M, et al. Differing rates of loss of DPC4 expression and of p53 overexpression among carcinomas of the proximal and distal bile ducts. Cancer. 2001 91 1332-1341. 

Floxuridine is a pyrimidine antimetabolite with its primary effect to interfere with the synthesis of deoxyribonucleic acid (DNA) and to a lesser extent inhibit the formation of ribonucleic acid (RNA). It is indicated in palliative management of GI adenocarcinoma metastatic to the liver administered by continuous regional intra-arterial infusion as long as cancer does not extend beyond the area perfused by a single artery. Floxuridine, an antimetabolite and anti-neoplastic agent (0.1 to 0.6 mg/kg daily by intra-arterial infusion), is used to treat brain, breast, head, neck, liver, gallbladder, and bile duct cancer (see also Figure 15). 

There are also some human epidemiological studies which show an association between occupational exposure to MC and increases in biliary (bile duct) cancer and a type of brain cancer. Other epidemiological studies have not observed a relationship between MC exposure and cancer. OSHA interprets these results to mean that there is suggestive (but not absolute) evidence that MC is a human carcinogen. 

Uttararvichen, T, Buddhiswasdi, V., and Pairojkul, C. (1996). Bile duct cancer and the liver fluke pathology, presentation and surgical management. Asian J. Surg. 19, 267-270. 

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