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Primary adenocarcinoma of the bile ducts

Clinical characteristics and natural history

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Abstract

Primary bile duct carcinoma is a malignancy with a poor prognosis, but recent diagnostic developments allow earlier detection and possibly improved chances for effective palliation or surgical cure. In order to increase the clinical understanding and awareness of this disorder, 43 patients with primary adenocarcinoma of the bile ducts were reviewed. The mean patient age was 63, and symptoms of nausea, abdominal pain, and pruritus were reported in a majority of patients. Documented weight loss, acholic stools, cutaneous icterus, and hepatomegaly were each present in a majority of patients. Serum bilirubin and alkaline phosphatase determinations were abnormal in 40 of 43 patients (93%), and cholangiography was the diagnostic study providing the most discriminating information. Locally invasive disease and biliary obstruction was the major cause of morbidity and mortality, and there was only one surgical cure. These data suggest that cholangiography and nonsurgical techniques for biliary drainage should be employed in most patients who are not optimal surgical candidates.

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References

  1. Sherlock S: Diseases of the Liver and Biliary System, 6th ed. Oxford, Blackwell Scientific Publications, 1981

    Google Scholar 

  2. Beazley RM, Hadjis N, Benjamin IS, Blumgart LH: Clinicopathological aspects of high bile duct cancer. Ann Surg 199:623–633, 1984

    Google Scholar 

  3. Blumgart LH: Biliary obstruction: new approaches to old problems. Am J Surg 135:19–31, 1978

    Google Scholar 

  4. Blumgart LH, Benjamin IS, Hadjis NS, Beazley R: Surgical approaches to cholangiocarcinoma at confluence of hepatic ducts. Lancet 1:66–70, 1984

    Google Scholar 

  5. Evander A, Fredlund P, Hoevels J, Ihse I, Bengmark S: Evaluation of aggressive surgery for carcinoma of the extrahepatic bile ducts. Ann Surg 191:23–29, 1980

    Google Scholar 

  6. Alexander F, Rossi RL, O'Bryan M, Kettry U, Braasch JW, Watkins E: Biliary carcinoma. Am J Surg 147:503–509, 1984

    Google Scholar 

  7. Mueller PR, van Sonnenberg E, Ferrucci JT: Percutaneous biliary drainage: Technical and catheter-related problems in 200 procedures. Am J Roentgenol 138:17–23, 1982

    Google Scholar 

  8. Cotton PB: Duodenoscopic placement of biliary prosthesis to relieve malignant obstructive jaundice. Br J Surg 69:501–503, 1982

    Google Scholar 

  9. Okuda K, Kubo Y, Okazaki N, et al: Clinical aspects of intrahepatic bile duct carcinoma including hilar carcinoma. Cancer 39:232–246, 1977

    Google Scholar 

  10. Ross AP, Braasch JW, Warren KW: Carcinoma of the proximal bile ducts. Surg Gynecol Obstet 136:923–928, 1973

    Google Scholar 

  11. Klatskin G: Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis. Am J Med 28:241–256, 1965

    Google Scholar 

  12. Kuwayti K, Baggenstoss AH, Stauffer MH, Priestly JT: Carcinoma of the major intrahepatic and the extrahepatic bile ducts exclusive of the papilla of Vater. Surg Gynecol Obstet 104:357–366, 1957

    Google Scholar 

  13. Reeder DD, Linovitz RJ, Torrance D, Neibling HA, Hirose F, Benfield JR: Cholangiocarcinoma and operative cholangiography. Arch Surg 103:25–30, 1971

    Google Scholar 

  14. Dillon E, Peel AG, Parkin GS: The diagnosis of primary bile duct carcinoma (cholangiocarcinoma) in the jaundiced patient. Clin Radiol 32:311–317, 1981

    Google Scholar 

  15. Whelton MJ, Petrelli M, George P, Young WB, Sherlock S: Carcinoma of the junction of the main hepatic ducts. Q J Med 38:211–229, 1969

    Google Scholar 

  16. Akwari OE, Van Heerden JA, Foulk WT, Baggenstoss AH: Cancer of the bile ducts associated with ulcerative colitis. Ann Surg 181:303–309, 1975

    Google Scholar 

  17. Ritchie JK, Allan RN, MacArtney J, Thompson H, Hawley PR, Cooke WT: Biliary tract carcinoma associated with ulcerative colitis. Q J Med 43:263–279, 1974

    Google Scholar 

  18. Wheeler PG, Dawson JL, Nunnerly H, Brinkley D, Laws J, Williams R: Newer techniques in the diagnosis and treatment of proximal bile duct carcinoma—an analysis of 41 consecutive patients. Q J Med 50:247–258, 1981

    Google Scholar 

  19. Kagawa Y, Kashihara S, Kuramoto S, Maetani S: Carcinoma arising in a congenitally dilated biliary tract. Gastroenterology 74:1286–1294, 1978

    Google Scholar 

  20. Bismuth H, Malt RA: Carcinoma of the biliary tract. N Engl J Med 301:704–706, 1979

    Google Scholar 

  21. Dahlgren S: Thorotrast tumors: A review of the literature and report of two cases. Acta Pathol Microbiol Scand 53:147–161, 1961

    Google Scholar 

  22. da Silva Horta J, da Motta LC, Abbott JD, Roriz ML: Malignancy and other late effects following administration of thorotrast. Lancet 2:201–205, 1965

    Google Scholar 

  23. Krain LS: Gallbladder and extrahepatic bile duct carcinoma. Geriatrics 12:111–117, 1972

    Google Scholar 

  24. Ingis DA, Farmer RG: Adenocarcinoma of the bile ducts. Am J Dig Dis 20:253–261, 1975

    Google Scholar 

  25. Chitwood WR, Meyers WC, Heaston DK, Herskoviz AM, McLeod ME, Jones RS: Diagnosis and treatment of primary extrahepatic bile duct tumors. Am J Surg 143:99–106, 1982

    Google Scholar 

  26. Gold RP, Casarella WJ, Stern C, Seaman WB: Transhepatic cholangiography: The radiologic method of choice in suspected obstructive jaundice. Radiology 133:39–44, 1979

    Google Scholar 

  27. Walter JF, Bookstein JJ, Bouffard EV: Newer angiographic observations in cholangiocarcinoma. Radiology 118:19–23, 1976

    Google Scholar 

  28. Reuter SR, Redman HC, Bookstein JJ: Angiography in carcinoma of the biliary tract. Br J Radiol 44:636–641, 1971

    Google Scholar 

  29. Kaude J, Rian R: Cholangiocarcinoma. Radiology 100: 573–580, 1971

    Google Scholar 

  30. Hoevels J, Ihse I: Percutaneous transhepatic portography in bile duct carcinoma. ROEFO 131:140–150, 1979

    Google Scholar 

  31. Adson MA, Farnell MS: Hepatobiliary cancer—surgical considerations. Mayo Clin Proc 56:686–699, 1981

    Google Scholar 

  32. Tompkins RK, Thomas D, Wile A, Longmire WP: Prognostic factors in bile duct carcinoma. Ann Surg 194:447–455, 1981

    Google Scholar 

  33. Terblanche J, Saunders SJ, Louw JH: Prolonged palliation in carcinoma of the main hepatic duct junction. Surgery 71:720–731, 1972

    Google Scholar 

  34. Terblanche J, Louw JH: U tube drainage in the palliative therapy of carcinoma of the main hepatic duct junction. Surg Clin North Am 53:1245–1256, 1973

    Google Scholar 

  35. Cameron JL, Gaylor BW, Zuidema GD: The use of silastic transhepatic stents in benign and malignant biliary strictures. Ann Surg 188:552–561, 1978

    Google Scholar 

  36. Berquist TH, May GR, Johnson CM, Adson MA, Thistle JL: Percutaneous biliary decompression: Internal and external drainage in 50 patients. Am J Roentgenol 136:901–906, 1981

    Google Scholar 

  37. Nilsson U, Evander A, Ihse I, Lunderquist A, Mocibob A: Percutaneous biliary decompression: Internal and external drainage in 50 patients. Am J Roentgenol 136:901–906, 1981

    Google Scholar 

  38. Hansson JA, Hoevels J, Simert G, Tyler U, Vang J: Clinical aspects of nonsurgical percuteneous transhepatic bile drainage in obstructive lesions of the extrahepatic bile ducts. Ann Surg 189:58–61, 1979

    Google Scholar 

  39. Gouma DJ, Wesdorp RC, Oostenbrock RJ, Soeters PB, Greep JM: Percutaneous transhepatic drainage and insertion of an endoprosthesis for obstructive jaundice. Am J Surg 145:763–768, 1983

    Google Scholar 

  40. Dooley JS, Dick R, Irving D, Olney J, Sherlock S: Relief of bile duct obstruction by the percutaneous insertion of an endoprosthesis. Clin Radiol 32:163–172, 1981

    Google Scholar 

  41. Siegel JH, Daniel SJ: Endoscopic and fluoroscopic transpapillary placement of a large caliber biliary endoprosthesis. Am J Gastroenterol 79:461–465, 1984

    Google Scholar 

  42. Rieman JF, Lux G, Rosch W, Beickert-Sterba A: Nonsurgical biliary drainage-technique, indications and results. Endoscopy 13:157–161, 1981

    Google Scholar 

  43. Huibregtse K, Havenkamp HJ, Tytgat GN: Transpapillary positioning of a large 3.2-mm endoprosthesis. Endoscopy 13:217–219, 1981

    Google Scholar 

  44. Zimmon DS, Chang J, Clemett AR: Advances in the management of bile duct obstruction. Med Clin North Am 63:593–609, 1979

    Google Scholar 

  45. Wanebo HJ, Grimes OF: Cancer of the bile duct: The occult malignancy. Am J Surg 130:262–268, 1975

    Google Scholar 

  46. Bukowski RM, Leichman LP, Rivkin SE: Phase II trial of m-AMSA in gallbladder and cholangiocarcinoma: A Southwest Oncology Group Study. Eur J Cancer Clin Oncol 19:721–723, 1983

    Google Scholar 

  47. Davis HL, Ramirez G, Ansfield FJ: Adenocarcinomas of stomach, pancreas, liver, and biliary tracts. Cancer 33: 193–197, 1974

    Google Scholar 

  48. Falkson G, Moertel CG, Lavin P, Pretorius FJ, Carbone PP: Chemotherapy studies in primary liver cancer. Cancer 42:2149–2156, 1978

    Google Scholar 

  49. Pilepich MV, Lambert PM: Radiotherapy of carcinomas of the extrahepatic biliary system. Radiology 127:767–770, 1978

    Google Scholar 

  50. Green N, Mikkelsen WP, Kernen JA: Cancer of the common hepatic bile ducts—palliative radiotherapy. Radiology 109:687–689, 1973

    Google Scholar 

  51. Smoron GL: Radiation therapy of carcinoma of gallbladder and biliary tract. Cancer 40:1422–1424, 1977

    Google Scholar 

  52. Fletcher MS, Dawson JL, Wheeler PG, Brinkley D, Nunnerley H, Williams R: Treatment of high bile duct carcinoma by internal radiotherapy with iridium-192 wire. Lancet 2:172–174, 1981

    Google Scholar 

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Authors and Affiliations

  1. Medical Service (General Internal Medicine Unit and Gastrointestinal Unit), Massachusetts General Hospital, 02114, Boston, Massachusetts

    Joel T. Bruggen MD, Mark S. McPhee MD, Paramjit S. Bhatia MD &  James M. Richter MD

  2. Department of Medicine, Harvard Medical School, Boston, Massachusetts

    Joel T. Bruggen MD, Mark S. McPhee MD, Paramjit S. Bhatia MD &  James M. Richter MD

  3. Departments of Medicine and Pathology, Kansas University Medical Center, 02114, Kansas City, Kansas

    Joel T. Bruggen MD, Mark S. McPhee MD, Paramjit S. Bhatia MD &  James M. Richter MD

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  1. Joel T. Bruggen MD
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  2. Mark S. McPhee MD
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  3. Paramjit S. Bhatia MD
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  4. James M. Richter MD
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Bruggen, J.T., McPhee, M.S., Bhatia, P.S. et al. Primary adenocarcinoma of the bile ducts. Digest Dis Sci 31, 840–846 (1986). https://doi.org/10.1007/BF01296053

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  • DOI: https://doi.org/10.1007/BF01296053

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