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Preneoplastic conditions underlying bile duct cancer

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Abstract

Background

Malignancies arising from the biliary tract can arise from the epithelial lining of the biliary tract and surrounding tissues. Conditions that predispose to malignancy as well as preneoplastic changes in biliary tract epithelia have been identified. In this overview, we discuss preneoplastic conditions of the biliary tract and emphasize their clinical relevance.

Results

Chronic biliary tract inflammation predisposes to cancer in the biliary tract. Biliary tract carcinogenesis involves a multistep process as a consequence of chronic biliary epithelial injury or inflammation. Reminiscent of other gastrointestinal epithelial malignancies such as gastric, colon, and pancreatic cancer, biliary tract cancers may evolve via multistep progression from epithelial hyperplasia and dysplasia to malignant transformation. The potential role of initiating cells is also becoming recognized.

Conclusions

In spite of improved risk factor recognition, and advances in diagnostic tools, the early diagnosis of pre-malignant or malignant biliary tract conditions is extremely challenging, and there is a paucity of evidence on which to base their management. As a result, the role of pre-emptive surgery remains largely undefined.

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Abbreviations

BilIN:

Biliary intra-epithelial neoplasia

ERCP:

Endoscopic retrograde cholangiopancreatography

FISH:

Fluorescence in situ hybridization

IPN-B:

Intraductal papillary neoplasm of the bile ducts

MRI/MRCP:

Magnetic resonance imaging/cholangiopancreatography

PSC:

Primary sclerosing cholangitis

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Acknowledgments

The study was supported in part by the National Institutes of Health grant DK 069370.

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  1. Department of Transplantation, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    Lena Sibulesky, Justin Nguyen & Tushar Patel

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  1. Lena Sibulesky
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  2. Justin Nguyen
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  3. Tushar Patel
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Correspondence to Tushar Patel.

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Sibulesky, L., Nguyen, J. & Patel, T. Preneoplastic conditions underlying bile duct cancer. Langenbecks Arch Surg 397, 861–867 (2012). https://doi.org/10.1007/s00423-012-0943-7

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