An Ignoble Experiment: Take the Latest AccessSurgery Quick Test on Biliary Tree Tumors!

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Quick Test posted on 6.27.11:

Biliary Tree Tumors

Most malignant biliary tumors are adenocarcinomas located in the hepatic or common bile duct. The histologic pattern varies from typical adenocarcinoma to tumors composed principally of fibrous stroma and few cells. The acellular tumors may be mistaken for benign strictures or sclerosing cholangitis if adequate biopsies are not obtained. About 10% are bulky papillary tumors, which tend to be less invasive and less apt to metastasize.

At presentation, metastases are uncommon, but the tumor has often grown into the portal vein or hepatic artery.

The illness presents with gradual onset of jaundice or pruritus. Chills, fever, and biliary colic are usually absent, and except for a deep discomfort in the right upper quadrant, the patient feels well. Bilirubinuria is present from the start, and light-colored stools are usual. Anorexia and weight loss develop insidiously with time.

Icterus is the most obvious physical finding. If the tumor is located in the common duct, the gallbladder may distend and become palpable in the right upper quadrant. The tumor itself is never palpable. Patients with tumors of the hepatic duct do not develop palpable gallbladders. Hepatomegaly is common. If obstruction is unrelieved, the liver may eventually become cirrhotic, and splenomegaly, ascites, or bleeding varices become secondary manifestations.

Table 35–6. TNM Staging of Extrahepatic Bile Duct Cancers

Stage 0	Tis	N0	M0
Stage IA	T1	N0	M0
Stage IB	T2	N0	M0
Stage IIA	T3	N0	M0
Stage IIB	T1–3	N1	M0
Stage III	T4	N0–1	M0
Stage IV	Any T	N0–1	M1

NOTE: Tis: carcinoma in situ; T1: cancer confined to bile duct wall; T2: cancer invades beyond wall of bile duct; T3: cancer invades liver, pancreas, and/or left or right branches of portal vein or hepatic artery; T4: cancer invades main portal vein or both its left and right branches, common hepatic artery, or other structures, such as colon, stomach, duodenum, or abdominal wall; N0: no regional lymph node metastasis; N1: regional lymph node metastasis present (regional lymph nodes consist of hilar, celiac, periduodenal, peripancreatic, and superior mesenteric groups); M0: no distant metastasis; M1: distant metastasis present.

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An Ignoble Experiment

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2011/06/28

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