Current management of cholangiocarcinoma.

Most bile duct cancers are multicentric, slow-growing, and only locally invasive adenocarcinomas. Approximately half involve the hepatic bifurcation. Percutaneous cholangiography is successful in over 90% of patients and is virtually diagnostic for proximal tumors. Therapeutic options include percutaneous intubation, surgery, radiation, and chemotherapy, though responses to the latter have been minimal. Percutaneous or endoscopic intubation as definitive therapy is generally reserved for elderly patients or those with advanced disease. Surgical procedures include resection, bypass, dilatation and stenting, and biopsy alone. Fewer than half of all upper bile duct cancers are resectable, so most patients have palliative procedures. Although several studies suggest a survival advantage with the addition of radiotherapy, no confirmatory data is available. The prognosis for cholangiocarcinoma remains dismal.