Abstract
Cholangiocarcinomas are a diverse group of tumors that are presumed to originate from the biliary tract epithelium either within the liver or the biliary tract. These cancers are often difficult to diagnose, their pathogenesis is poorly understood, and their dismal prognosis has resulted in a nihilistic approach to their management. The two major clinical phenotypes are intrahepatic, mass-forming tumors and large ductal tumors. Among the ductal cancers, lesions at the liver hilum are most prevalent. The risk factors, clinical presentation, natural history and management of these two types of cholangiocarcinoma are distinct. Efforts to improve outcomes for patients with these diseases are affected by several challenges to effective management. For example, designations based on anatomical characteristics have been inconsistently applied, which has confounded analysis of epidemiological trends and assessment of risk factors. The evaluation of therapeutic options, particularly systemic therapies, has been limited by a lack of appreciation of the different phenotypes. Controversies exist regarding the appropriate workup and choice of management approach. However, new and emerging tools for improved diagnosis, expanded indications for surgical approaches, an emerging role for locoregional and intrabiliary therapies and improved systemic therapies provide optimism and hope for improved outcomes in the future.
Key Points
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Cholangiocarcinomas are a diverse group of tumors that occur within the liver and biliary tract and are thought to originate from the epithelial lining of the biliary tract
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The two major clinical phenotypes of cholangiocarcinoma are intrahepatic and ductal tumors (further divided into lesions that arise at the liver hilum or the extrahepatic ductal system)
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Macroscopic (mass-forming, sclerosing or polypoid) and microscopic (cholangiocellular or hepatocellular) are additional subclassifications that might correlate with biological behavior and therapeutic response
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Inconsistent use of designations based on anatomical characteristics has confounded analysis of epidemiological trends and a lack of appreciation of the different phenotypes has limited the evaluation of systemic therapies
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Appropriate evaluation and choice of management approach requires a multidisciplinary approach; a multimodality approach to the management of patients with these cancers should be considered
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Emerging new tools for improved diagnosis, expanded indications for surgical approaches, an emerging role for locoregional and intrabiliary therapies and improved systemic therapies might improve outcomes in the future
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References
Welzel, T. M. et al. Risk factors for intrahepatic and extrahepatic cholangiocarcinoma in the United States: a population-based case-control study. Clin. Gastroenterol. Hepatol. 5, 1221–1228 (2007).
Shaib, Y. H. et al. Risk factors for intrahepatic and extrahepatic cholangiocarcinoma: a hospital-based case-control study. Am. J. Gastroenterol. 102, 1016–1021 (2007).
Welzel, T. M., McGlynn, K. A., Hsing, A. W., O'Brien, T. R. & Pfeiffer, R. M. Impact of classification of hilar cholangiocarcinomas (Klatskin tumors) on the incidence of intra- and extrahepatic cholangiocarcinoma in the United States. J. Natl Cancer Inst. 98, 873–875 (2006).
Patel, T. Worldwide trends in mortality from biliary tract malignancies. BMC Cancer 2, 10 (2002).
Patel, T. Increasing incidence and mortality of primary intrahepatic cholangiocarcinoma in the United States. Hepatology 33, 1353–1357 (2001).
Patel, T. Cholangiocarcinoma. Nat. Clin. Pract. Gastroenterol. Hepatol. 3, 33–42 (2006).
DeOliveira, M. L. et al. Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann. Surg. 245, 755–762 (2007).
Nagino, M. et al. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann. Surg. 243, 364–372 (2006).
Hemming, A. W., Reed, A. I., Fujita, S., Foley, D. P. & Howard, R. J. Surgical management of hilar cholangiocarcinoma. Ann. Surg. 241, 693–699 (2005).
Rea, D. J., Rosen, C. B., Nagorney, D. M., Heimbach, J. K. & Gores, G. J. Transplantation for cholangiocarcinoma: when and for whom? Surg. Oncol. Clin. N. Am. 18, 325–337 (2009).
Valle, J. et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N. Engl. J. Med. 362, 1273–1281 (2010).
Gao, F., Bai, Y., Ma, S. R., Liu, F. & Li, Z. S. Systematic review: photodynamic therapy for unresectable cholangiocarcinoma. J. Hepatobiliary Pancreat. Sci. 17, 125–131 (2010).
Ortner, M. A. Photodynamic therapy for cholangiocarcinoma: overview and new developments. Curr. Opin. Gastroenterol. 25, 472–476 (2009).
Quyn, A. J., Ziyaie, D., Polignano, F. M. & Tait, I. S. Photodynamic therapy is associated with an improvement in survival in patients with irresectable hilar cholangiocarcinoma. HPB (Oxford) 11, 570–577 (2009).
Ortner, M. E. et al. Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study. Gastroenterology 125, 1355–1363 (2003).
Jinawath, N. et al. Comparison of gene expression profiles between Opisthorchis viverrini and non-Opisthorchis viverrini associated human intrahepatic cholangiocarcinoma. Hepatology 44, 1025–1038 (2006).
Yang, B., House, M. G., Guo, M., Herman, J. G. & Clark, D. P. Promoter methylation profiles of tumor suppressor genes in intrahepatic and extrahepatic cholangiocarcinoma. Mod. Pathol. 18, 412–420 (2005).
Xu, M. J. et al. Identification and characterization of microRNAs in Clonorchis sinensis of human health significance. BMC Genomics 11, 521 (2010).
Kawahigashi, Y. et al. MicroRNA profiling of human intrahepatic cholangiocarcinoma cell lines reveals biliary epithelial cell-specific microRNAs. J. Nippon Med. Sch. 76, 188–197 (2009).
Meng, F. et al. Involvement of human micro-RNA in growth and response to chemotherapy in human cholangiocarcinoma cell lines. Gastroenterology 130, 2113–2129 (2006).
Nakeeb, A. et al. Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors. Ann. Surg. 224, 463–473 (1996).
Sano, T. et al. Prognosis of perihilar cholangiocarcinoma: hilar bile duct cancer versus intrahepatic cholangiocarcinoma involving the hepatic hilus. Ann. Surg. Oncol. 15, 590–599 (2008).
Ebata, T. et al. The concept of perihilar cholangiocarcinoma is valid. Br. J. Surg. 96, 926–934 (2009).
Klatskin, G. Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. An unusual tumor with distinctive clinical and pathological features. Am. J. Med. 38, 241–256 (1965).
Farges, O. & Fuks, D. Clinical presentation and management of intrahepatic cholangiocarcinoma. Gastroenterol. Clin. Biol. 34, 191–199 (2010).
Gatto, M. & Alvaro, D. Cholangiocarcinoma: risk factors and clinical presentation. Eur. Rev. Med. Pharmacol. Sci. 14, 363–367 (2010).
Khan, S. A., Toledano, M. B. & Taylor-Robinson, S. D. Epidemiology, risk factors, and pathogenesis of cholangiocarcinoma. HPB (Oxford) 10, 77–82 (2008).
Singh, P. & Patel, T. Advances in the diagnosis, evaluation and management of cholangiocarcinoma. Curr. Opin. Gastroenterol. 22, 294–299 (2006).
Shaib, Y. H., El-Serag, H. B., Davila, J. A., Morgan, R. & McGlynn, K. A. Risk factors of intrahepatic cholangiocarcinoma in the United States: a case-control study. Gastroenterology 128, 620–626 (2005).
Chung, Y. E. et al. Varying appearances of cholangiocarcinoma: radiologic-pathologic correlation. Radiographics 29, 683–700 (2009).
Yamasaki, S. Intrahepatic cholangiocarcinoma: macroscopic type and stage classification. J. Hepatobiliary Pancreat. Surg. 10, 288–291 (2003).
Slattery, J. M. & Sahani, D. V. What is the current state-of-the-art imaging for detection and staging of cholangiocarcinoma? Oncologist 11, 913–922 (2006).
Chung, Y. E. et al. Varying appearances of cholangiocarcinoma: radiologic-pathologic correlation. Radiographics 29, 683–700 (2009).
Nathan, H. & Pawlik, T. M. Staging of intrahepatic cholangiocarcinoma. Curr. Opin. Gastroenterol. 26, 269–273 (2010).
Edge, S. et al. (Eds) AJCC Cancer Staging Manual 7th edn (Springer, Chicago, 2009).
Farges, O. et al. AJCC 7th edition of TNM staging accurately discriminates outcomes of patients with resectable intrahepatic cholangiocarcinoma: by the AFC-IHCC-2009 study group. Cancer doi:10.1002/cncr.25712.
Kokudo, N. & Arita, J. Staging for intrahepatic cholangiocarcinoma. Liver Int. 30, 931–933 (2010).
Nathan, H. et al. A proposed staging system for intrahepatic cholangiocarcinoma. Ann. Surg. Oncol. 16, 14–22 (2009).
Carpizo, D. R. & D'Angelica, M. Management and extent of resection for intrahepatic cholangiocarcinoma. Surg. Oncol. Clin. N. Am. 18, 289–305 (2009).
Giuliante, F. et al. Liver resection for intrahepatic cholangiocarcinoma. Tumori 91, 487–492 (2005).
Poultsides, G. A., Zhu, A. X., Choti, M. A. & Pawlik, T. M. Intrahepatic cholangiocarcinoma. Surg. Clin. North Am. 90, 817–837 (2010).
Yokoyama, Y. et al. Value of indocyanine green clearance of the future liver remnant in predicting outcome after resection for biliary cancer. Br. J. Surg. 97, 1260–1268 (2010).
Murakami, Y. et al. Prognostic factors after surgical resection for intrahepatic, hilar, and distal cholangiocarcinoma. Ann. Surg. Oncol. doi: 10.1245/s10434-010-1325-4.
Burger, I. et al. Transcatheter arterial chemoembolization in unresectable cholangiocarcinoma: initial experience in a single institution. J. Vasc. Interv. Radiol. 16, 353–361 (2005).
Ahmadzadehfar, H., Biersack, H. J. & Ezziddin, S. Radioembolization of liver tumors with yttrium-90 microspheres. Semin. Nucl. Med. 40, 105–121 (2010).
Hong, K. & Geschwind, J. F. Locoregional intra-arterial therapies for unresectable intrahepatic cholangiocarcinoma. Semin. Oncol. 37, 110–117 (2010).
Kiefer, M. V. et al. Chemoembolization of intrahepatic cholangiocarcinoma with cisplatinum, doxorubicin, mitomycin C, ethiodol, and polyvinyl alcohol: a 2-center study. Cancer doi:10.1002/cncr.25625.
Carrafiello, G. et al. Radiofrequency ablation of intrahepatic cholangiocarcinoma: preliminary experience. Cardiovasc. Intervent. Radiol. 33, 835–839 (2010).
Chiou, Y. Y. et al. Percutaneous ultrasound-guided radiofrequency ablation of intrahepatic cholangiocarcinoma. Kaohsiung J. Med. Sci. 21, 304–309 (2005).
Kim, J. H. et al. Radiofrequency ablation for recurrent intrahepatic cholangiocarcinoma after curative resection. Eur. J. Radiol. doi:10.1016/j.ejrad.2010.09.019.
Kopek, N., Holt, M. I., Hansen, A. T. & Hoyer, M. Stereotactic body radiotherapy for unresectable cholangiocarcinoma. Radiother. Oncol. 94, 47–52 (2010).
Czito, B. G., Anscher, M. S. & Willett, C. G. Radiation therapy in the treatment of cholangiocarcinoma. Oncology (Williston Park) 20, 873–884 (2006).
Chen, Y. X. et al. Determining the role of external beam radiotherapy in unresectable intrahepatic cholangiocarcinoma: a retrospective analysis of 84 patients. BMC Cancer 10, 492 (2010).
Tse, R. V. et al. Phase I study of individualized stereotactic body radiotherapy for hepatocellular carcinoma and intrahepatic cholangiocarcinoma. J. Clin. Oncol. 26, 657–664 (2008).
Glimelius, B. et al. Chemotherapy improves survival and quality of life in advanced pancreatic and biliary cancer. Ann. Oncol. 7, 593–600 (1996).
Hezel, A. F. & Zhu, A. X. Systemic therapy for biliary tract cancers. Oncologist 13, 415–423 (2008).
Mazhar, D., Stebbing, J. & Bower, M. Chemotherapy for advanced cholangiocarcinoma: what is standard treatment? Future Oncol. 2, 509–514 (2006).
Park, J. et al. Natural history and prognostic factors of advanced cholangiocarcinoma without surgery, chemotherapy, or radiotherapy: a large-scale observational study. Gut Liver 3, 298–305 (2009).
Cho, S. Y. et al. Survival analysis of intrahepatic cholangiocarcinoma after resection. Ann. Surg. Oncol. 17, 1823–1830 (2010).
Kassahun, W. T. & Jonas, S. Spectrum of benign lesions mimicking a malignant stricture at the liver hilum. Rev. Recent Clin. Trials 4, 185–194 (2009).
Sasaki, R. et al. Evaluation of UICC-TNM and JSBS staging systems for surgical patients with extrahepatic cholangiocarcinoma. Langenbecks Arch. Surg. 395, 615–623 (2010).
Bismuth, H. & Corlette, M. B. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver. Surg. Gynecol. Obstet. 140, 170–178 (1975).
Bismuth, H., Nakache, R. & Diamond, T. Management strategies in resection for hilar cholangiocarcinoma. Ann. Surg. 215, 31–38 (1992).
Jarnagin, W. R. et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann. Surg. 234, 507–517 (2001).
Blechacz, B. R., Sanchez, W. & Gores, G. J. A conceptual proposal for staging ductal cholangiocarcinoma. Curr. Opin. Gastroenterol. 25, 238–239 (2009).
Connor, S. et al. The utility of laparoscopic assessment in the preoperative staging of suspected hilar cholangiocarcinoma. J. Gastrointest. Surg. 9, 476–480 (2005).
El-Hanafy, E. Pre-operative biliary drainage in hilar cholangiocarcinoma, benefits and risks, single center experience. Hepatogastroenterology 57, 414–419 (2010).
Liu, F., Li, Y., Wei, Y. & Li, B. Preoperative biliary drainage before resection for hilar cholangiocarcinoma: whether or not? A systematic review. Dig. Dis. Sci. doi:10.1007/s10620-010-1338-7.
Nagino, M. et al. Preoperative biliary drainage for biliary tract and ampullary carcinomas. J. Hepatobiliary Pancreat. Surg. 15, 25–30 (2008).
Regimbeau, J. M. et al. Surgery for hilar cholangiocarcinoma: a multi-institutional update on practice and outcome by the AFC-HC Study Group. J. Gastrointest. Surg. doi:10.1007/s11605-011-1414-0.
Shimizu, H. et al. Aggressive surgical resection for hilar cholangiocarcinoma of the left-side predominance: radicality and safety of left-sided hepatectomy. Ann. Surg. 251, 281–286 (2010).
Lee, S. G. et al. Surgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience. J. Hepatobiliary Pancreat Sci. 17, 476–589 (2010).
Neuhaus, P. et al. Extended resections for hilar cholangiocarcinoma. Ann. Surg. 230, 808–818 (1999).
Jarnagin, W. R. et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann. Surg. 234, 507–517 (2001).
Capussotti, L., Muratore, A., Polastri, R., Ferrero, A. & Massucco, P. Liver resection for hilar cholangiocarcinoma: in-hospital mortality and longterm survival. J. Am. Coll. Surg. 195, 641–647 (2002).
Seyama, Y. et al. Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann. Surg. 238, 73–83 (2003).
Kawasaki, S. et al. Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann. Surg. 238, 84–92 (2003).
Hemming, A. W., Reed, A. I., Fujita, S., Foley, D. P. & Howard, R. J. Surgical management of hilar cholangiocarcinoma. Ann. Surg. 241, 693–699 (2005).
Sano, T. et al. One hundred two consecutive hepatobiliary resections for perihilar cholangiocarcinoma with zero mortality. Ann. Surg. 244, 240–247 (2006).
Shimizu, H. et al. Aggressive surgical resection for hilar cholangiocarcinoma of the left-side predominance: radicality and safety of left-sided hepatectomy. Ann. Surg. 251, 281–286 (2010).
Nagino, M. et al. Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma: an audit of 50 consecutive cases. Ann. Surg. 252, 115–123 (2010).
Anderson, C. & Kim, R. Adjuvant therapy for resected extrahepatic cholangiocarcinoma: a review of the literature and future directions. Cancer Treat. Rev. 35, 322–327 (2009).
Sagawa, N., Kondo, S., Morikawa, T., Okushiba, S. & Katoh, H. Effectiveness of radiation therapy after surgery for hilar cholangiocarcinoma. Surg. Today 35, 548–552 (2005).
Vern-Gross, T. Z. et al. Survival outcomes in resected extrahepatic cholangiocarcinoma: effect of adjuvant radiotherapy in a surveillance, epidemiology, and end results analysis. Int. J. Radiat. Oncol. Biol. Phys. doi:10.1016/j.ijrobp.2010.05.001.
Schoenthaler, R. et al. Carcinoma of the extrahepatic bile ducts. The University of California at San Francisco experience. Ann. Surg. 219, 267–274 (1994).
Rea, D. J. et al. Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma. Ann. Surg. 242, 451–458 (2005).
Soderlund, C. & Linder, S. Covered metal versus plastic stents for malignant common bile duct stenosis: a prospective, randomized, controlled trial. Gastrointest. Endosc. 63, 986–995 (2006).
Brugge, W. R. Endoscopic techniques to diagnose and manage biliary tumors. J. Clin. Oncol. 23, 4561–4565 (2005).
Simmons, D. T. et al. A novel endoscopic approach to brachytherapy in the management of Hilar cholangiocarcinoma. Am. J. Gastroenterol. 101, 1792–1796 (2006).
Qian, X. J., Zhai, R. Y., Dai, D. K., Yu, P. & Gao, L. Treatment of malignant biliary obstruction by combined percutaneous transhepatic biliary drainage with local tumor treatment. World J. Gastroenterol. 12, 331–335 (2006).
Nag, S., DeHaan, M., Scruggs, G., Mayr, N. & Martin, E. W. Long-term follow-up of patients of intrahepatic malignancies treated with iodine-125 brachytherapy. Int. J. Radiat. Oncol. Biol. Phys. 64, 736–744 (2006).
Shim, C. S. et al. Prospective study of the effectiveness of percutaneous transhepatic photodynamic therapy for advanced bile duct cancer and the role of intraductal ultrasonography in response assessment. Endoscopy 37, 425–433 (2005).
Matull, W. R. et al. R0 but not R1/R2 resection is associated with better survival than palliative photodynamic therapy in biliary tract cancer. Liver Int. 31, 99–107 (2011).
Witzigmann, H. et al. Surgical and palliative management and outcome in 184 patients with hilar cholangiocarcinoma: palliative photodynamic therapy plus stenting is comparable to r1/r2 resection. Ann. Surg. 244, 230–239 (2006).
Zen, Y. et al. Proposal of histological criteria for intraepithelial atypical/proliferative biliary epithelial lesions of the bile duct in hepatolithiasis with respect to cholangiocarcinoma: preliminary report based on interobserver agreement. Pathol. Int. 55, 180–188 (2005).
Zen Y. et al. Biliary intraepithelial neoplasia: an international interobserver agreement study and proposal for diagnostic criteria. Mod. Pathol. 20, 701–709 (2007).
Wu, T. T., Levy, M., Correa, A. M., Rosen, C. B. & Abraham, S. C. Biliary intraepithelial neoplasia in patients without chronic biliary disease: analysis of liver explants with alcoholic cirrhosis, hepatitis C infection, and noncirrhotic liver diseases. Cancer 115, 4564–4575 (2009).
Gatto, M. et al. Cholangiocarcinoma: update and future perspectives. Dig. Liver Dis. 42, 253–260 (2010).
Levy, C. et al. The value of serum CA 19–9 in predicting cholangiocarcinomas in patients with primary sclerosing cholangitis. Dig. Dis. Sci. 50, 1734–1740 (2005).
Iwatsuki, S. et al. Treatment of hilar cholangiocarcinoma (Klatskin tumors) with hepatic resection or transplantation. J. Am. Coll. Surg. 187, 358–64 (1988).
Rosen, C. B., Heimbach, J. K. & Gores, G. J. Liver transplantation for cholangiocarcinoma. Transpl. Int. 23, 692–697 (2010).
Sorensen, H. T. et al. Risk of liver and other types of cancer in patients with cirrhosis: a nationwide cohort study in Denmark. Hepatology 28, 921–925 (1998).
Hakamada, K. et al. Late development of bile duct cancer after sphincteroplasty: a ten- to twenty-two-year follow-up study. Surgery 121, 488–492 (1997).
Su, C. H., Shyr, Y. M., Lui, W. Y. & P'Eng, F. K. Hepatolithiasis associated with cholangiocarcinoma. Br. J. Surg. 84, 969–973 (1997).
Donato, F. et al. Intrahepatic cholangiocarcinoma and hepatitis C and B virus infection, alcohol intake, and hepatolithiasis: a case-control study in Italy. Cancer Causes Control 12, 959–964 (2001).
Lee, T. Y. et al. Hepatitis B virus infection and intrahepatic cholangiocarcinoma in Korea: a case-control study. Am. J. Gastroenterol. 103, 1716–1720 (2008).
Kobayashi, M. et al. Incidence of primary cholangiocellular carcinoma of the liver in Japanese patients with hepatitis C virus-related cirrhosis. Cancer 88, 2471–2477 (2000).
Charlier, C. et al. Cholangiocarcinoma in HIV-infected patients with a history of cholangitis. J. Acquir. Immune. Defic. Syndr. 39, 253–255 (2005).
Lowenfels, A. B. & Norman, J. Isoniazid and bile duct cancer. JAMA 240, 434–435 (1978).
Yen, S., Hsieh, C. C. & MacMahon, B. Extrahepatic bile duct cancer and smoking, beverage consumption, past medical history, and oral-contraceptive use. Cancer 59, 2112–2116 (1987).
Rubel, L. R. & Ishak, K. G. Thorotrast-associated cholangiocarcinoma: an epidemiologic and clinicopathologic study. Cancer 50, 1408–1415 (1982).
Wong, O., Whorton, M. D., Foliart, D. E. & Ragland, D. An industry-wide epidemiologic study of vinyl chloride workers, 1942–1982. Am. J. Ind. Med. 20, 317–334 (1991).
Szendroi, M., Nemeth, L. & Vajta, G. Asbestos bodies in a bile duct cancer after occupational exposure. Environ. Res. 30, 270–280 (1983).
Lipsett, P. A., Pitt, H. A., Colombani, P. M., Boitnott, J. K. & Cameron, J. L. Choledochal cyst disease. A changing pattern of presentation. Ann. Surg. 220, 644–652 (1994).
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I apologize to the many excellent contributors to this field whose work is not acknowledged in the reference list owing to space limitations. This work was supported by NIH grant DK069370.C. P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape, LLC-accredited continuing medical education activity associated with this article.
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Patel, T. Cholangiocarcinoma—controversies and challenges. Nat Rev Gastroenterol Hepatol 8, 189–200 (2011). https://doi.org/10.1038/nrgastro.2011.20
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