Loading...
Please wait, while we are loading the content...
Similar Documents
Cholangiocarcinoma
| Content Provider | Scilit |
|---|---|
| Author | Gores, Gregory |
| Copyright Year | 2004 |
| Abstract | Cholangiocarcinoma is a highly malignant disease, originating from the ductular epithelia of the extrahepatic and intrahepatic biliary apparatus. Unfortunately, the incidence of this aggressive malignancy is increasing in western societies. Both diagnosis and management are complex and difficult. Moreover, there are a plethora of diagnostic and management approaches depending on the context of the disease. Therefore, this issue of Seminars in Liver Disease. devoted to the topic of cholangiocarcinoma, is both timely and topical. In the first article, Shaib and El-Serag review the epidemiology of cholangiocarcinoma. This is a wonderful contribution, highlighting in detail the increasing incidence of this malignancy in western cultures. Risk factors, especially the occurrence of primary sclerosing cholangitis and other inflammatory conditions of the biliary tree, are discussed in detail. Unfortunately, there does not appear to be any epidemiological information that would suggest which patients with primary sclerosing cholangitis are at either high or low risk for the development of this malignancy. This remains a problematic clinical dilemma in a hepatologic practice. This contribution sets the background for the remainder of this issue, which deals with diagnostic and management problems. In the second article, Berthiaume and Wands review the molecular pathogenesis of cholangiocarcinoma. Well-established cancers in general must develop autonomous proliferating signals, inhibit apoptosis, and develop mechanisms to ensure adequate nutrient supply. The latter phenomenon primarily occurs via angiogenesis. The authors describe in detail the mechanisms by which cholangiocarcinoma cells initiate autonomous signaling pathways and evade apoptosis. Classic pathways relevant to this malignancy that initiate angiogenesis are reviewed. The authors also highlight a novel protein, which appears to be upregulated only by cholangiocarcinomas: human aspartyl (asparaginyl) beta-hydroxylase. This protein appears to be important in cell migration, motility, and likely metastases. Moreover, it is a surface protein and unique antibodies can be targeted to this protein. These unique antibodies may ultimately prove to have therapeutic value in the treatment of this cancer. The elucidation of these molecular pathways opens a wide variety of potential diagnostic and screening strategies aimed toward earlier diagnosis when surgery may be more efficacious and may also provide a multitude of molecular targets for future therapeutic approaches. Cholangiocarcinomas are relatively acellular, highly desmoplastic cancers that are difficult to diagnose confidently. In an evidence-based approach, Nehls, Gregor, and Klump review the usefulness of a variety of serum and bile markers for cholangiocarcinoma. In the era of proteomics and genomics, this is a particularly useful contribution to this issue of Seminars in Liver Disease. In a very comprehensive and impressively thorough manner, the authors review all of the serum markers that have been studied in this disease. Serum signaling CA 19-9 values have the greatest use in this disease, although the ability to detect early lesions is unclear. The role of detecting epigenetic or genetic lesions, or both, in bile is also thoroughly reviewed. Of the genes involved in the genesis of cholangiocarcinoma, the P16INK4A appears to be an important locus in the genesis of, and therefore in the diagnosis of, this cancer. P16 loss of heterozygosity or promoter hypermethylation, or both, is common in this malignancy, and they have both been used as diagnostic tools. Finally, the authors review the role of cytological techniques such as digital image analysis and fluorescent in situ hybridization for detecting this malignancy. The authors conclude that cytological techniques evaluating DNA aneuploidy are extremely promising for detecting early cholangiocarcinoma. Such techniques are now being rapidly established at a variety of institutions and should greatly aid in our diagnostic armamentarium for this difficult to diagnosis cancer. Manfredi and colleagues review the role of magnetic resonance (MR) imaging for diagnosing and staging this cancer. Cholangiocarcinomas are difficult to visualize, and surgical approaches need to take into consideration the relationship of the tumor to the two lobes of the liver, involvement or lack of involvement of secondary biliary radicals, and encasement of vessels and extrahepatic and intrahepatic metastases. In the past, staging of cholangiocarcinoma was difficult and required multiple imaging modalities. However, MR imaging has apparently supplanted this approach because of the availability of MR cross-sectional imaging, MR cholangiograms and MR angiography. Thus, in many instances, MR imaging appears to be able to stage the disease with one imaging modality. This is a significant advance, and the authors point out the strengths and weaknesses of MR imaging for the diagnosis and staging of this cancer. Cholangiocarcinoma often presents with bile duct obstruction. Indeed the cholestasis contributes to the morbidity and mortality of this disease. Therefore, endoscopic stenting of biliary obstruction is an important tool in the management of this disease. Abu-Hamda and Baron extensively review current concepts in regard to stenting these lesions. The indications for metallic versus plastic stenting are discussed. The authors discuss bilateral versus unilateral stenting for optimal relief of biliary obstruction. This article will be of great practical value to endoscopists, physicians, and surgeons working with endoscopists in the management of these patients. Recently, photodynamic therapy has emerged as a potential therapeutic modality for the treatment of cholangiocarcinoma. Photodynamic therapy consists of the administration of a photosensitizing agent followed by the administration of light of the... |
| Related Links | http://www.thieme-connect.de/products/ejournals/pdf/10.1055/s-2004-828898.pdf |
| Ending Page | 114 |
| Page Count | 2 |
| Starting Page | 113 |
| ISSN | 02728087 |
| e-ISSN | 10988971 |
| DOI | 10.1055/s-2004-828898 |
| Journal | Seminars in Liver Disease |
| Issue Number | 02 |
| Volume Number | 24 |
| Language | English |
| Publisher | Georg Thieme Verlag KG |
| Publisher Date | 2004-05-01 |
| Access Restriction | Open |
| Subject Keyword | Journal: Seminars in Liver Disease Gastroenterology and Hepatology Extrahepatic and Intrahepatic Em Class |
| Content Type | Text |
| Resource Type | Article |
| Subject | Hepatology |
