Cholangiocarcinoma: Emerging approaches to a challenging cancer

PURPOSE OF REVIEW: Cholangiocarcinomas are malignancies arising from biliary tract epithelia that are associated with a poor prognosis. The diagnosis, evaluation and management of these tumors continue to be clinically challenging. In this review, we will discuss recent information that may influence the approach to the diagnosis and management of this devastating tumor. RECENT FINDINGS: Epidemiological studies are defining patient groups at increased risk of cancer in regions of low prevalence. Emerging approaches that may improve evaluation and management include the potential use of genomic and proteomic markers, cytogenetic and digital image analysis, endoscopic ultrasound with fine needle aspiration, and cholangioscopy. Adoption of aggressive surgical approaches along with the use of preoperative portal vein embolization, hepatic and caudate lobe resection and preoperative laparoscopy may improve survival. SUMMARY: Recent conceptual and technical advances will impact the clinical approach to cholangiocarcinoma and offer the promise of improving outcomes from this difficult tumor.