Biliary tract cancer

Introduction to biliary cancer The biliary tract cancer malignanttumorofbiliarytract includes the primary biliary tract, the common hepatic duct, and the primary tumor in the common bile duct area. It refers to the extrahepatic biliary malignant tumor originating from the confluence of the left and right hepatic ducts to the lower end of the common bile duct. Primary biliary tract cancer is rare, accounting for 0.01% to 0.46% of common autopsy, 2% of autopsy in cancer patients, and 0.3% to 1.8% of biliary surgery. In Europe and the United States, gallbladder cancer is 1.5 to 5 times that of biliary tract cancer. In Japan, biliary tract cancer is more than gallbladder cancer. The ratio of men to women is about 1.5 to 3.0. The age of onset is mostly 50 to 70 years old, but it can also be seen in young people. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: cholangiocarcinoma

Causes of biliary cancer

1. The site of occurrence of extrahepatic biliary tract cancer. Anatomically, according to the site of cancer, extrahepatic biliary tract cancer can be divided into: 1 or so hepatocarcinoma; 2 hepatocellular carcinoma; 3 cystic duct cancer; 4 hepatic duct, cystic duct and common bile duct junction; 5 gallbladder General cancer.

2. The general form of extrahepatic biliary tract cancer: extrahepatic biliary tract cancer can be divided into three types in general morphology: 1 wall infiltration type: visible in any part of the biliary tract, the most common. As the affected wall thickens, the lumen can become smaller or narrower, and blockage can occur. 2 nodular type: less common than the wall infiltration type, can be seen in the more advanced biliary tract cancer, the diameter of the cancer nodules can be 1.5 ~ 5.0cm. 3 intraluminal papillary type: the least seen, can be seen in any part of the biliary tract, but the confluence is more rare. This type can completely block the biliary cavity. In addition to mainly growing into the lumen, the cancer tissue can further infiltrate into the wall of the tube.

3. Histological types of extrahepatic biliary tract cancer: according to the type of cancer cells, the degree of differentiation and the growth pattern of cancer tissues. Extrahepatic biliary tract cancer can be divided into the following 6 types: 7 papillary adenocarcinoma: except for the invasive type of the wall, almost all of them are intraluminal papillary. 2 well-differentiated adenocarcinoma: the most in biliary tract cancer, can account for more than 2 / 3, can be found in any part. The cancer tissue infiltrates and grows in the wall of the tube, surrounding the entire wall. Infiltrating cancerous tissues are of varying sizes and irregularly shaped glandular structures, and some can be enlarged into cystic cavities. 3 poorly differentiated adenocarcinoma: that is, poorly differentiated adenocarcinoma, the part of the cancer tissue has a glandular structure, and some are irregular solid pieces, which also diffuse infiltration and growth in the wall of the tube. 4 undifferentiated cancer: less common. Some small cells are not differentiated from cancer, and are the same as undifferentiated carcinoma of the gallbladder. The cancer cells are diffusely infiltrated in the biliary wall and have less interstitial. Cancer tissue invades much and often invades adipose tissue or adjacent organs around the biliary tract. 5 signet ring cell carcinoma: less common. It is composed of mucin-containing cancer cells of varying degrees of differentiation, like the signet ring cell carcinoma of the gallbladder or the gastrointestinal tract. Cancer cells have no structure and diffuse infiltration. 6 squamous cell carcinoma: rare. Its tissue morphology is the same as that seen in other organs.

4. Diffusion and metastasis of extrahepatic biliary tract cancer: In the early stage, there were fewer metastases, mainly spreading directly along the biliary wall up and down. The above paragraph of hepatocellular carcinoma can directly invade the liver, which is more common than the middle and lower stages of cancer. The most common is lymph node metastasis of the hilar, but also lymph nodes in other parts of the abdominal cavity. Blood transfer, unless it is advanced cancer, is generally less. The biliary tract cancer in each part is most common in liver metastasis, especially in high biliary tract cancer. The cancer tissue easily invades the portal vein and forms a cancerous thrombus, which can lead to liver metastasis. It can also be transferred to the adjacent organs pancreas and gallbladder.

Biliary cancer prevention

The prognosis of biliary tract cancer is extremely poor. The surgical resection group generally had an average survival of 13 months and rarely survived for 5 years. Such as single or intra-biliary drainage, the average survival is only 6 to 7 months, rarely more than 1 year.

In the first year after surgery, it will be reviewed every 3 months. In the second year, it will be reviewed every six months, and then every year.

Biliary tract cancer complications Complications, cholangiocarcinoma

Cholangiocarcinoma, gallbladder cancer.

Biliary cancer symptoms Common symptoms Skin itching, pain, loss of appetite, jaundice, gray stool, lymph node enlargement, abdominal mass, nausea and vomiting, weight loss, fever, chills

Progressive obstructive jaundice is the main symptom of biliary tract cancer, often accompanied by itchy skin. About half of the patients were accompanied by upper abdominal pain and fever, but to a lesser extent. A small number of patients may have biliary tract symptoms, and about half of the patients have loss of appetite and weight loss. Whether the gallbladder is swollen or not depends on the location of the biliary tract cancer. The liver often has swelling, which can be found under the ribs or under the xiphoid process. Its texture is hard and the tenderness is not obvious. In the later stage, portal vein hypertension such as splenomegaly and ascites may occur.

Examination of biliary tract cancer

Medical examination

Pay attention to the general condition of the patient, body temperature, pulse, respiration and blood pressure, the condition and procedure of the sclera and skin jaundice, whether the supraclavicular lymph nodes are swollen, whether there is tenderness in the abdomen, how the liver texture is, whether there is tenderness, whether the gallbladder is swollen or tender. Whether the spleen is swollen, whether there is ascites and abdominal mass, if necessary, anal finger examination.

test

(1) Liver function test: containing bilirubin, transaminase, cholesterol, cholesterol ester ratio, white, globulin and protein electrophoresis, alkaline phosphatase, lactate dehydrogenase, -glutamyltransferase.

(2) blood biochemical examination: total potassium, sodium, chlorine, carbon dioxide, blood sugar, blood amylase renal function test.

(3) Hepatitis B virus serological indicators, as well as alpha-fetoprotein, CEA and CA19-9.

(4) Determination of bleeding time, clotting time and prothrombin time.

(5) Determination of urinary bilirubin, urobilin, urobilinogen and urinary amylase. Pay attention to the color of the stool and occult blood, and check the original fecal gallbladder.

Diagnosis and diagnosis of biliary tract cancer

In addition to the above clinical manifestations, the following auxiliary examinations should be performed.

1. Laboratory examination: mainly manifested as abnormal liver function of obstructive jaundice, such as increased bilirubin and alkaline phosphatase.

2. B-ultrasound: repeated and careful B-ultrasound can show dilated biliary tract, obstruction, and even tumor. The biliary tract cancer and ultrasound images may be lumps, strips, protrusions, and thrombus. The intrahepatic biliary tract cancer often has a mass or a strip. The hilar carcinoma is often cord-like, and the lower biliary cancer is often a protrusion. Type, hepatic portal thrombosis may be liver cancer, gallbladder cancer or metastatic cancer. Because biliary dilatation occurs before jaundice, B-ultrasound has the value of diagnosing early biliary tract cancer.

3. PTC: It is the main method for diagnosing biliary tract cancer. It can show the location and extent of biliary tract cancer, and the diagnosis rate can reach 94% to 100%.

4. CT: The basic CT manifestation of biliary tract cancer is 7 as a significant expansion of the proximal biliary tract of biliary tract cancer. The bile duct wall close to the tumor is thickened, and the biliary tract is more clear and enhanced when the scan is enhanced, and the lumen is unplanned and narrowed. Tumor shadows of soft tissue density can generally be found, with a CT value of 50 Hu and an enhanced CT value of 60-80 Hu during enhanced scanning. 2 Tumors mostly infiltrate along the biliary wall. The biliary wall is thickened and the edges are not clear, which can be enhanced and easily displayed during enhanced scanning. A small number of polypoid or nodular growth into the lumen, nodules are soft tissue density. 3 The tumor infiltrates into the cavity and the edge of the tube wall is blurred. Often invade the gallbladder liver, adjacent blood vessels and lymphoid tissue. The soft tissue shadows are unevenly distributed, the shape is irregular, the organizational structure is ambiguous, and the boundaries are unclear.

5. ERCP: The duodenal papilla can be directly observed, and the angiography can show the obstruction of the distal biliary tract.

6. Angiography: Angiography can better determine whether biliary tract cancer can be removed.

7. Cytological examination: Expand the sinus insertion fiber choledochoscopy based on PTCD, and directly observe and clamp the mass biopsy. Bile cytology can be performed when performing PTC or PTCD.

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