Adenocarcinoma of the bile ducts. Relationship of anatomic location to clinical features.

Case histories of 23 patients with adenocarcinoma of the bile ducts presenting at the Cleveland Clinic from January 1960 through March 1974 were reviewed and a comparison was made between carcinoma in the hepatic duct system and carcinomas in the common bile ducts. There were 14 cases of hepatic duct carcinoma and 9 cases of carcinoma of the common bile ducts. It was found that age, sex, presenting symptoms, physical examination, and laboratory findings were similar regardless of the location of the carcinoma. Moreover, the location of the carcinoma did not influence whether the correct diagnosis was made at the initial operation. Percutaneous cholangiography, operative cholangiography, and endoscopic retrograde cholangio-pancreatography (ERCP) were successful in making the diagnosis in both locations. The tumors differed in pathology. The hepatic duct carcinomas were often scirrhous; the more distal carcinomas were adenocarcinomas of varied grades of differentiation. The location influenced the type of surgery; resection was more common in the distal common bile duct cases. The average survival rate was less than 2 years for both locations. Radiation and/or 5-fluorouracil therapy did not appear to increase this survival rate. Since the prognosis is so poor, attention must focus on means of earlier diagnosis.