담관암

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목차

1. Introduction
2. Risk factor
3. Classification
4. TNM staging
5. Clinical Presentation
6. Diagnosis
7. Management
8. Prognosis

본문내용

1. Intrahepatic (6%)
2. Perihilar (67%)
- Type I : confined to common hepatic duct
- Type II : bifurcation without intrahepatic duct
- Type IIIa : Rt. secondary intrahepatic duct
- Type IIIb : Lt. secondary intrahepatic duct
- Type IV : both secondary intrahepatic duct
3. Distal (27%)
TNM staging
T1
Tumor confined to bile duct
T2
Tumor invades beyond the wall of the bile duct
T3
Tumor invades the liver, gallbladder, pancreas, and/or unilateral branches of the portal vein (right or left) or hepatic artery (right or left)
T4
Tumor invades any of the following main portal vein or its branches bilaterally, common hepatic artery, or other adjacent structure, such as the colon, stomach, duodenum, or abdominal wall
N0
No regional lymph node metastasis
N1
Regional lymph node metastasis
M0
No distant metastasis
M1
distant metastasis
Stage
Stage Grouping
IA
T1 N0 M0
IB
T2 N0 M0
IIA
T3 N0 M0
IIB
T1 N1 M0
T2 N1 M0
T3 N1 M0
III
T4 Any N M0
IV
Any T Any N M1
Clinical Presentation
1. Jaundice
1) 90% in perihilar or distal tumors
2) Intrahepatic : rarely until late course
2. Pruritus, fever, mild abdominal pain
3. Fatigue, anorexia, weight loss
4. Cholangitis : after biliary manipulation
Diagnosis
1. Serum total bilirubin
>10 mg/dL in perihilar & distal
2. Increased alkaline phosphatase, serum CA19-9
3. Initial imaging : abdominal ultrasound, CT
4. Perihilar

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