Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Lancet. 2014 Jun 21;383(9935):2168-79. doi: 10.1016/S0140-6736(13)61903-0. Epub 2014 Feb 26.
Cholangiocarcinoma represents a diverse group of epithelial cancers united by late diagnosis and poor outcomes. Specific diagnostic and therapeutic approaches are undertaken for cholangiocarcinomas of different anatomical locations (intrahepatic, perihilar, and distal). Mixed hepatocellular cholangiocarcinomas have emerged as a distinct subtype of primary liver cancer. Clinicians need to be aware of intrahepatic cholangiocarcinomas arising in cirrhosis and properly assess liver masses in this setting for cholangiocarcinoma. Management of biliary obstruction is obligatory in perihilar cholangiocarcinoma, and advanced cytological tests such as fluorescence in-situ hybridisation for aneusomy are helpful in the diagnosis. Liver transplantation is a curative option for selected patients with perihilar but not with intrahepatic or distal cholangiocarcinoma. International efforts of clinicians and scientists are helping to identify the genetic drivers of cholangiocarcinoma progression, which will unveil early diagnostic markers and direct development of individualised therapies.
胆管癌是一组具有不同表型的上皮性恶性肿瘤,其共同特点为诊断较晚,预后较差。不同解剖部位(肝内、肝门周围和远端)的胆管癌有其特定的诊断和治疗方法。混合性肝细胞胆管癌已成为原发性肝癌的一个独特亚型。临床医生需要注意肝硬化相关的肝内胆管癌,并在这种情况下对肝脏肿块进行适当评估以排除胆管癌。肝门周围胆管癌必须进行胆道梗阻的处理,高级细胞学检测如荧光原位杂交(FISH)有助于诊断非整倍体。肝移植是肝门周围胆管癌的一种根治性选择,但对于肝内或远端胆管癌则不行。临床医生和科学家的国际合作有助于确定胆管癌进展的遗传驱动因素,这将揭示早期诊断标志物,并指导个体化治疗的发展。