10/12/2015 Cholangiocarcinoma Followup: Further Outpatient Care, Complications, Prognosis

http://emedicine.medscape.com/article/277393followup 1/3

Cholangiocarcinoma FollowupAuthor: Peter E Darwin, MD; Chief Editor: Jules E Harris, MD, FACP, FRCPC more...

Updated: Mar 26, 2015

Further Outpatient CareMost patients with cholangiocarcinoma require followup care for acute and lateadverse effects of therapy. Aggressive followup care also is necessary to treatsymptoms from tumor recurrence and persistence. Patients with the best prognosismay be seen every 23 months with periodic laboratory and imaging studies (eg, CTscan).

Patients treated palliatively may enter hospice programs rapidly, as median survivalduration is only 28 months.

ComplicationsComplications include the following:

Infection of the biliary tree (ie, cholangitis) may result fromcholangiocarcinoma and subsequent obstruction of the duct.Between 10 and 20% of patients with cholangiocarcinoma develop cirrhosis.This may be secondary biliary cirrhosis resulting from neoplastic obstructionof the bile ducts or related to underlying fibrosis from primary sclerosingcholangitis.Other complications are usually the result of diagnostic and therapeuticprocedures.

PrognosisPatients with perihilar tumors that are completely resected may achieve longtermsurvival. Prognosis is poorest for patients with intrahepatic tumors.

Patients with distal extrahepatic tumors may have the best hope for survival iftumors are excised completely; tumors at this site are the most likely to beresectable. These patients may experience a 5year survival rate as high as 40%.The median survival duration in patients who undergo resection and postoperativechemoradiation may be as high as 1727.5 months. A study by Polistina et al foundthat chemoradiation given by stereotactic body radiotherapy plus gemcitabine offershigh local control rates and is a promising treatment.[26]

An intermediate prognosis (ie, median survival duration of 717 mo) is achieved forpatients who are unable to undergo resection but can tolerate adjuvantchemoradiation or possibly photodynamic therapy.

The poorest prognosis is for the patient with unresectable disease, with or withoutovert metastatic disease, who can tolerate only palliative stent placement.

A study by Ghafoori et al found that patients with locally advanced extrahepaticcholangiocarcinoma have poor survival with rare longterm survival. Most patientstreated with external beam radiation therapy (EBRT) had local control at the time ofdeath, which suggests that symptoms related to the local tumor effect may becontrolled using radiation therapy. The authors concluded that novel approaches areindicated in the therapy for this condition.[27]

Contributor Information and DisclosuresAuthorPeter E Darwin, MD Professor of Medicine, Director of GI Endoscopy, Department of Medicine, Division ofGastroenterology, University of Maryland School of Medicine

Peter E Darwin, MD is a member of the following medical societies: American Society for GastrointestinalEndoscopy

Disclosure: Nothing to disclose.

Coauthor(s)Andrew Scott Kennedy, MD PhysicianinChief, Radiation Oncology

Andrew Scott Kennedy, MD is a member of the following medical societies: Alpha Omega Alpha, AmericanAssociation for Cancer Research, American Society for Radiation Oncology, Radiological Society of NorthAmerica, Americas HepatoPancreatoBiliary Association, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Jennifer Lynn Bonheur, MD Attending Physician, Division of Gastroenterology, Lenox Hill Hospital

Jennifer Lynn Bonheur, MD is a member of the following medical societies: American GastroenterologicalAssociation, American Society for Gastrointestinal Endoscopy, New York Society for Gastrointestinal Endoscopy,New York Academy of Sciences, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor BoardFrancisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center Collegeof Pharmacy; EditorinChief, Medscape Drug Reference

10/12/2015 Cholangiocarcinoma Followup: Further Outpatient Care, Complications, Prognosis

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Disclosure: Received salary from Medscape for employment. for: Medscape.

Benjamin Movsas, MD

Benjamin Movsas, MD is a member of the following medical societies: American College of Radiology, AmericanRadium Society, American Society for Radiation Oncology

Disclosure: Nothing to disclose.

Chief EditorJules E Harris, MD, FACP, FRCPC Clinical Professor of Medicine, Section of Hematology/Oncology, Universityof Arizona College of Medicine, Arizona Cancer Center

Jules E Harris, MD, FACP, FRCPC is a member of the following medical societies: American Association for theAdvancement of Science, American Society of Hematology, Central Society for Clinical and TranslationalResearch, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

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