Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA.
Hepatology. 2011 Nov;54(5):1842-52. doi: 10.1002/hep.24570.
Primary sclerosing cholangitis (PSC) is a chronic fibroinflammatory syndrome involving the biliary tract, often accompanied by inflammatory bowel disease (IBD). This syndrome is a prototype disease linking chronic inflammation to carcinogenesis. Indeed, PSC is associated with an increased risk of cholangiocarcinoma (CCA), gallbladder cancer, hepatocellular carcinoma (HCC), and colorectal cancer. Herein, we review the risk for these malignancies in PSC and discuss rational cancer surveillance strategies for these patients. Where evidence is limited, we suggest a pragmatic approach. In this regard, we recommend interval screening for CCA with noninvasive imaging modalities and serum carbohydrate antigen 19-9 determinations annually. These imaging studies also serve to screen for gallbladder cancer and HCC. Screening for colorectal cancer is more firmly established in PSC patients with IBD and includes colonoscopy at the time of PSC diagnosis and, thereafter, at 1-2-year intervals. We also highlight areas where more information is required, such as management of biliary tract dysplasia and cancer chemoprevention in PSC.
原发性硬化性胆管炎（PSC）是一种累及胆道的慢性纤维炎症综合征，常伴有炎症性肠病（IBD）。该综合征是一种将慢性炎症与致癌作用联系起来的典型疾病。事实上，PSC 与胆管癌（CCA）、胆囊癌、肝细胞癌（HCC）和结直肠癌的风险增加相关。在此，我们回顾了 PSC 中这些恶性肿瘤的风险，并讨论了针对这些患者的合理癌症监测策略。在证据有限的情况下，我们建议采取务实的方法。在这方面，我们建议每年通过非侵入性影像学检查和血清碳水化合物抗原 19-9 测定来筛查 CCA。这些影像学研究还可用于筛查胆囊癌和 HCC。在伴有 IBD 的 PSC 患者中，结直肠癌的筛查更为明确，包括在 PSC 诊断时进行结肠镜检查，然后每 1-2 年进行一次。我们还强调了需要更多信息的领域，例如胆道发育不良的管理和 PSC 的癌症化学预防。
