Cholangiocarcinoma, according to the statistics of the world medical community, accounts for about 2% of all types of cancer, as well as up to 10% of the total number of liver and biliary tract cancers. At the same time, the diagnosis of this type of tumor is very low: only 1.5-2%. Klatskin's tumor is named after pathologist Gerald Klatskin, a physician from America. In 1965, while working at Yale University, he, based on 13 cases of the disease, described all the features of this disease.
Cholangiocarcinoma, or cancer of the liver and bile ducts
Klatskin's tumor is a rather dangerous disease. This neoplasm is characterized by slow growth and late development of metastases. Due to late diagnosis and the impossibility of surgical removal, the disease has a high mortality rate. In most cases, the diagnosis is made at the last stages of development of formations, which excludes surgical intervention. The development of metastases directly affects the liver,gates of the liver, regional lymph nodes, as well as the abdominal cavity. Tumor growth originates from the cells of the liver epithelium. The disease is formed mainly after 50 years, but every year the age of patients decreases. Men are slightly more affected than women.
Probable causes of a tumor
The causes of liver cholangiocarcinoma are not exactly known. But scientists have found out the factors, the influence of which increases the risk of developing a neoplasm. Patients with a history of primary sclerotizing cholangitis may develop Klatskin's disease in 40 cases out of 100.
Tumor occurs in 25 cases out of 100 based on hereditary diseases such as Caroli's disease. Inflammatory reaction due to intrahepatic parasites can trigger a neoplasm.
Bad habits that affect the he alth of the liver: smoking, alcohol addiction, malnutrition, resulting in obesity - undeniable factors for the progression of the disease. The presence of cholelithiasis increases the likelihood of a tumor. At risk are people exposed to prolonged contact with toxins and harmful substances. Viral infections, mainly hepatitis, contribute to the development of cancers.
Symptoms of cholangiocarcinoma
Since liver cancer is difficult to diagnose, you need to listen to your body for early detection of Klatskin's disease.
Tumor canbe characterized by symptoms such as:
- the main symptom of the disease is obstructive jaundice;
- constant feeling of itching;
- drawing pain in the upper right abdomen;
- loss of appetite resulting in dramatic weight loss;
- physical exhaustion characteristic of tumor formations;
- fever with Klatskin tumor also occurs;
- changes in color of urine and stools (urine darkens and stools lighter).
Symptoms appear unexpectedly and progress. Obstructive jaundice occurs in 90 out of 100 cases and is one of the frequent signs of a disease such as Klatskin's tumor. Reviews of patients sometimes differ. Some patients note the addition of itching, pain and sudden weight loss. Such manifestations are due to the late stages of malignant tumors. But others feel little or no change in their he alth or attribute their symptoms to other ailments.
Diagnosis of Klatskin's tumor
To establish the diagnosis, a number of clinical studies are carried out, which can accurately indicate the presence of Klatskin's disease. The tumor is clearly visible during screening on an ultrasound machine. This is a fairly economical, harmless and easily accessible method. With the help of spiral computed tomography, it is easy to detect abnormalities in the gallbladder, to see damage to the liver and lymph nodes. The use of MRI (magnetic resonance imaging), with the introduction of a contrast fluid into the liver, allows you to accurately determine the condition of the liver tissues andthe degree of narrowing of the bile ducts in the diagnosis of Klatskin's tumor. The photo shows all parts of the liver and bile ducts.
X-ray and x-ray examination shows problems with the biliary tract. During the diagnostic process, a contrast agent is injected, which allows you to see the outflow of bile. Biochemical blood tests will help determine the level of enzymes and bilirubin. Tests for the detection of oncological bodies can also be prescribed: CA 199, CA 125.
Quite often, tumor processes reach the hepatic artery and portal vein, which supply blood to the liver. Before surgery, it is very important to determine the stage of the neoplasm in order to clarify whether the disease has spread to the blood vessels. In some cases, such a diagnosis is difficult, and then the issue of the scale of resection is decided during the surgical operation.
Methods of treating neoplasms
If left untreated, most patients have an average life expectancy of 6 months after an accurate diagnosis. At an early stage, Klatskin's disease is rarely detected. The tumor can be treated in the last stages rather ineffectively.
Surgery is one of the main ways to treat a tumor. But due to late diagnosis, the operation has a low survival rate (average 20%). To achieve a positive effect, the complete removal of the damaged part of the bile ducts is used, together with the removalone lobe of the liver, in order to avoid infection of the blood vessels.
Surgery is possible in several cases:
- the formation did not affect the circulatory system of the liver; in this case, it is possible to remove a section or the entire lobe of the damaged liver;
- the formation did not affect the bile duct of one or both lobes of the liver.
A disease is considered inoperable when the tumor penetrates into the blood vessels of the liver or into the choleretic ducts of both of its lobes.
Palliative care
In inoperable cases or as adjunctive therapy, palliative care is used.
Such methods include:
- biliary drainage;
- chemotherapy;
- radiotherapy;
- bypass;
- photodynamic therapy;
- Irradiation with highly focused ultrasound beams.
By combining several therapies together with early diagnosis, life expectancy can be increased from 10 months to 5 years.
Prognosis after treatment
Due to the fact that the processes of tumor formation in the liver are rather slow, life expectancy is from one and a half to five years. Complete removal of damaged areas allows you to increase life expectancy with accurate and timely diagnosis of Klatskin's disease.
A tumor found inside the liver has a bleak prognosis. This is one of the worst indicators observed in patients withinoperable formations with metastases. Such patients can only rely on drainage of the biliary tract. If a Klatskin tumor is diagnosed inside the liver, the life expectancy of the diseased sometimes does not exceed several weeks.
The cause of death, oddly enough, is not metastases, but concomitant complications. These include:
- cirrhosis of the liver caused by improper flow of bile;
- infections leading to abscess formation;
- general atrophy of the body and failure of immunity;
- purulent-inflammatory processes.
Preventive measures
To prevent tumor diseases of the liver and bile ducts, it is necessary to adhere to proper nutrition, not to abuse alcohol and to prevent infection with parasites.
If there is a history of diseases that are positioned as risk factors, then timely treatment and systematic examination should be carried out for early detection of abnormalities in the functioning of the bile-forming organs. It is also necessary to exclude exposure to harmful substances, for example in the workplace.
In conclusion
Modern diagnostic equipment can detect tumor processes in the liver and bile ducts, as well as determine the degree of complexity of surgical intervention. The use of new methods of prompt resolution of the problem, transplantation and additional therapeutic measures leads to an increase in the quality and life expectancy of patients.
