Location of cholangiocarcinoma
|C||Distal bile duct distal common bile duct|
(Ref: Schwartz surgery, 8th edition pg – 1215)
a. Over 95% of bile duct cancers are adenocarcinomas. Morphologically they are divided into nodular (the most common type), scirrhous, diffusely infiltrating, or papillary.
b. Anatomically they are divided into distal, proximal, or perihilar tumors.
c. Intrahepatic cholangiocarcinomas occur, but they are treated like hepatocellular carcinoma, with hepatectomy when possible.
d. About two-thirds of cholangiocarcinomas are located in the perihilar location.
e. Perihilar cholangiocarcinomas, also referred to as Klatskin tumors, are further classified based on anatomic location by the Bismuth-Corlette classification
Type I – Common hepatic duct
Type II – Bi furcation without secondary intrahepatic duct involvement.
Type IIIa – Extension into Right intra hepatic duct
Type III b- Extension into Left intra hepatic duct
Type IV – Extension into both intrahepatic duct.
Investigation of choice for Klatskin’s tumor is MRCP.