Biliary tract

Extrahepatic cholangiocarcinoma encompasses both hilar and distal cholangiocarcinoma. The incidence is varied worldwide but has been associated with various infectious and inflammatory conditions, such as primary sclerosing cholangitis (PSC) and liver fluke infection, as well as other predisposing factors, such as biliary adenoma and choledochal cyst. Surgical resection offers the only chance of cure, but fewer than half of patients are resectable at the time of presentation. Work-up includes CT (chest, abdomen and pelvis) and imaging of the biliary system with either magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ECRP). In locally-advanced or metastatic disease, chemotherapy is the treatment of choice (gemcitabine and cisplatin combination), except in highly selected patients with locally-advanced hilar cholangiocarcinoma, for whom neoadjuvant chemoradiation and liver transplantation may be possible at specialized centres.