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| __NOTOC__ | | __NOTOC__ |
| {{Cholangiocarcinoma}} | | {{Cholangiocarcinoma}} |
| {{CMG}} | | |
| | {{CMG}}; {{AE}} {{F.K}}, {{PSK}} |
| ==Overview== | | ==Overview== |
| | Common [[risk factors]] in the development of cholangiocarcinoma include [[primary sclerosing cholangitis]], fibropolycystic liver disease such as [[choledochal cysts]], [[hepatolithiasis]] and recurrent pyogenic [[cholangitis]]. |
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| ==Risk Factors== | | ==Risk Factors== |
| Clinical data has suggested that the development of cholangiocarcinoma is related to several factors.<ref name=radio>Cholangiocarcinoma. Radiopaedia. http://radiopaedia.org/articles/cholangiocarcinoma</ref>
| | *Common risk factors in the development of cholangiocarcinoma include primary sclerosing cholangitis, fibropolycystic liver disease such as [[choledochal cysts]], [[hepatolithiasis]] and recurrent pyogenic [[cholangitis]]. |
| '''Chronic inflammation of the bile duct''':
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| *Primary sclerosing cholangitis (major risk factor in western countries) | | ===Common Risk Factors=== |
| *Recurrent pyogenic cholangitis (major risk factor in endemic areas) | | *Common risk factors in the development of cholangiocarcinoma include:<ref name="pmid23694797">{{cite journal |vauthors=Al-Bahrani R, Abuetabh Y, Zeitouni N, Sergi C |title=Cholangiocarcinoma: risk factors, environmental influences and oncogenesis |journal=Ann. Clin. Lab. Sci. |volume=43 |issue=2 |pages=195–210 |year=2013 |pmid=23694797 |doi= |url=}}</ref><ref name="pmid21488076">{{cite journal |vauthors=Tyson GL, El-Serag HB |title=Risk factors for cholangiocarcinoma |journal=Hepatology |volume=54 |issue=1 |pages=173–84 |year=2011 |pmid=21488076 |pmc=3125451 |doi=10.1002/hep.24351 |url=}}</ref><ref name="pmid17625428">{{cite journal |vauthors=Ben-Menachem T |title=Risk factors for cholangiocarcinoma |journal=Eur J Gastroenterol Hepatol |volume=19 |issue=8 |pages=615–7 |year=2007 |pmid=17625428 |doi=10.1097/MEG.0b013e328224b935 |url=}}</ref><ref name="pmid20496549">{{cite journal |vauthors=Gatto M, Alvaro D |title=Cholangiocarcinoma: risk factors and clinical presentation |journal=Eur Rev Med Pharmacol Sci |volume=14 |issue=4 |pages=363–7 |year=2010 |pmid=20496549 |doi= |url=}}</ref><ref name="pmid15529594">{{cite journal |vauthors=Acalovschi M |title=Cholangiocarcinoma: risk factors, diagnosis and management |journal=Rom J Intern Med |volume=42 |issue=1 |pages=41–58 |year=2004 |pmid=15529594 |doi= |url=}}</ref> |
| | **[[Primary sclerosing cholangitis]] |
| | **[[Cirrhosis]] |
| | **Viral infections |
| | ***[[HIV]] |
| | ***[[EBV]] |
| | ***[[Hepatitis]] viruses |
| | ****[[Hepatitis B]] |
| | ****[[Hepatitis C]] |
| | **[[Liver fluke]] infections |
| | **[[Hepatolithiasis]] |
| | **[[Choledochal cysts]] |
| | **Infusion of certain chemical agents such as naphthenic acids |
| | **Recurrent pyogenic [[cholangitis]] |
| | **[[Opisthorchis viverrini]] |
| | **[[Clonorchis sinensis]] |
| | **Caroli's disease |
| | **Inherited disorders |
| | ***[[Lynch syndrome]] |
| | ***Biliary papillomatosis |
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| *Ulcerative colitis
| | ===Less Common Risk Factors=== |
| *Cholelithiasis
| | *Less common risk factors in the development of cholangiocarcinoma include:<ref name="pmid22982100">{{cite journal |vauthors=Razumilava N, Gores GJ |title=Classification, diagnosis, and management of cholangiocarcinoma |journal=Clin. Gastroenterol. Hepatol. |volume=11 |issue=1 |pages=13–21.e1; quiz e3–4 |year=2013 |pmid=22982100 |pmc=3596004 |doi=10.1016/j.cgh.2012.09.009 |url=}}</ref> |
| *Choledochal cysts
| | **[[Thorotrast]] |
| *Cirrhosis
| | **[[Diabetes]] |
| | | **[[Obesity]] |
| '''Liver fluke infections''': Liver fluke infection is a major cause of cholangiocarcinoma in some Asian countries.
| | **[[Alcohol]] consumption |
| | | **[[Smoking]] |
| *Opisthorchis viverrini
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| *Clonorchis sinensis (clonorchiasis)
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| '''Choledochal cysts''':
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| *Caroli's disease
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| '''Toxins'''
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| *Thorotrast(widely used as a contrast agent for x-rays until 1950s)
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| *Dioxin
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| *Polyvinyl chloride
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| *Heavy alcoholism
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| '''Viral infections'''
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| *HIV
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| *Hepatitis B
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| *Hepatitis C
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| *EBV
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| '''Inherited disorders'''
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| *Lynch syndrome II
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| *Biliary papillomatosis
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| '''Obesity'''
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| [[Image:Clonorchis sinensis LifeCycle.gif|thumb|left|150px|Life cycle of ''[[Clonorchis sinensis]]'', a [[liver fluke]] associated with cholangiocarcinoma]]
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| A number of [[risk factor]]s for the development of cholangiocarcinoma have been described; in the Western world, the most common of these is [[primary sclerosing cholangitis]] (PSC), an [[inflammatory disease]] of the bile ducts which is in turn closely associated with [[ulcerative colitis]] (UC).<ref>{{cite journal |author=Chapman R |title=Risk factors for biliary tract carcinogenesis |journal=Ann Oncol |volume=10 Suppl 4 |issue= |pages=308-11 |year= |id=PMID 10436847}}</ref> Epidemiologic studies have suggested that the lifetime risk of developing cholangiocarcinoma for a person with PSC is 10%–15%,<ref>Epidemiologic studies which have addressed the incidence of cholangiocarcinoma in people with primary sclerosing cholangitis include the following:
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| *{{cite journal |author=Bergquist A, Ekbom A, Olsson R, Kornfeldt D, Lööf L, Danielsson A, Hultcrantz R, Lindgren S, Prytz H, Sandberg-Gertzén H, Almer S, Granath F, Broomé U |title=Hepatic and extrahepatic malignancies in primary sclerosing cholangitis |journal=J Hepatol |volume=36 |issue=3 |pages=321-7 |year=2002 |id=PMID 11867174}}
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| *{{cite journal |author=Bergquist A, Glaumann H, Persson B, Broomé U |title=Risk factors and clinical presentation of hepatobiliary carcinoma in patients with primary sclerosing cholangitis: a case-control study |journal=Hepatology |volume=27 |issue=2 |pages=311-6 |year=1998 |id=PMID 9462625}}
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| *{{cite journal |author=Burak K, Angulo P, Pasha T, Egan K, Petz J, Lindor K |title=Incidence and risk factors for cholangiocarcinoma in primary sclerosing cholangitis |journal=Am J Gastroenterol |volume=99 |issue=3 |pages=523-6 |year=2004 |id=PMID 15056096}}</ref> although autopsy series have found rates as high as 30% in this population. The mechanism by which PSC increases the risk of cholangiocarcinoma is not well-understood. | |
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| Certain [[parasitic disease|parasitic liver diseases]] may be risk factors as well. Colonization with the [[liver fluke]]s ''[[Opisthorchis viverrini]]'' (found in Thailand, Laos, and Malaysia) or ''[[Clonorchis sinensis]]'' (found in Japan, Korea, and Vietnam) has been associated with the development of cholangiocarcinoma.<ref>{{cite journal |author=Watanapa P |title=Cholangiocarcinoma in patients with opisthorchiasis |journal=Br J Surg |volume=83 |issue=8 |pages=1062–64 |year=1996 |id=PMID 8869303}}</ref><ref>{{cite journal |author=Watanapa P, Watanapa W |title=Liver fluke-associated cholangiocarcinoma |journal=Br J Surg |volume=89 |issue=8 |pages=962-70 |year=2002 |id=PMID 12153620}}</ref><ref>{{cite journal |author=Shin H, Lee C, Park H, Seol S, Chung J, Choi H, Ahn Y, Shigemastu T |title=Hepatitis B and C virus, Clonorchis sinensis for the risk of liver cancer: a case-control study in Pusan, Korea |journal=Int J Epidemiol |volume=25 |issue=5 |pages=933-40 |year=1996 |id=PMID 8921477}}</ref> Patients with chronic liver disease, whether in the form of viral hepatitis (e.g. [[hepatitis B]] or [[hepatitis C|C]]),<ref>{{cite journal |author=Kobayashi M, Ikeda K, Saitoh S, Suzuki F, Tsubota A, Suzuki Y, Arase Y, Murashima N, Chayama K, Kumada H |title=Incidence of primary cholangiocellular carcinoma of the liver in Japanese patients with hepatitis C virus-related cirrhosis |journal=Cancer |volume=88 |issue=11 |pages=2471–7 |year=2000 |id=PMID 10861422}}</ref><ref>{{cite journal |author=Yamamoto S, Kubo S, Hai S, Uenishi T, Yamamoto T, Shuto T, Takemura S, Tanaka H, Yamazaki O, Hirohashi K, Tanaka T |title=Hepatitis C virus infection as a likely etiology of intrahepatic cholangiocarcinoma |journal=Cancer Sci |volume=95 |issue=7 |pages=592-5 |year=2004 |id=PMID 15245596}}</ref><ref>{{cite journal |author=Lu H, Ye M, Thung S, Dash S, Gerber M |title=Detection of hepatitis C virus RNA sequences in cholangiocarcinomas in Chinese and American patients |journal=Chin Med J (Engl) |volume=113 |issue=12 |pages=1138–41 |year=2000 |id=PMID 11776153}}</ref> [[alcoholic liver disease]], or [[cirrhosis]] from other causes, are at increased risk of cholangiocarcinoma.<ref>{{cite journal |author=Sorensen H, Friis S, Olsen J, Thulstrup A, Mellemkjaer L, Linet M, Trichopoulos D, Vilstrup H, Olsen J |title=Risk of liver and other types of cancer in patients with cirrhosis: a nationwide cohort study in Denmark |journal=Hepatology |volume=28 |issue=4 |pages=921-5 |year=1998 |id=PMID 9755226}}</ref> HIV infection was also identified in one study as a potential risk factor for cholangiocarcinoma, although it was unclear whether [[HIV]] itself or correlated factors (e.g. hepatitis C infection) were responsible for the association.
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| [[Congenital disorder|Congenital]] liver abnormalities, such as [[Caroli's syndrome]] or choledochal cysts, have been associated with an approximately 15% lifetime risk of developing cholangiocarcinoma.<ref>{{cite journal |author=Lipsett P, Pitt H, Colombani P, Boitnott J, Cameron J |title=Choledochal cyst disease. A changing pattern of presentation |journal=Ann Surg |volume=220 |issue=5 |pages=644-52 |year=1994 |id=PMID 7979612}}</ref><ref>{{cite journal |author=Dayton M, Longmire W, Tompkins R |title=Caroli's Disease: a premalignant condition? |journal=Am J Surg |volume=145 |issue=1 |pages=41-8 |year=1983 |id=PMID 6295196}}</ref> The rare inherited disorders [[Lynch syndrome|Lynch syndrome II]] and biliary papillomatosis are associated with cholangiocarcinoma.<ref>{{cite journal |author=Mecklin J, Järvinen H, Virolainen M |title=The association between cholangiocarcinoma and hereditary nonpolyposis colorectal carcinoma |journal=Cancer |volume=69 |issue=5 |pages=1112–4 |year=1992 |id=PMID 1310886}}</ref><ref>{{cite journal |author=Lee S, Kim M, Lee S, Jang S, Song M, Kim K, Kim H, Seo D, Song D, Yu E, Lee S, Min Y |title=Clinicopathologic review of 58 patients with biliary papillomatosis |journal=Cancer |volume=100 |issue=4 |pages=783-93 |year=2004 |id=PMID 14770435}}</ref> The presence of gallstones ([[cholelithiasis]]) is not clearly associated with cholangiocarcinoma. However, intrahepatic stones (so-called hepatolithiasis), which are rare in the West but common in parts of Asia, have been strongly associated with cholangiocarcinoma.<ref>{{cite journal |author=Lee C, Wu C, Chen G |title=What is the impact of coexistence of hepatolithiasis on cholangiocarcinoma? |journal=J Gastroenterol Hepatol |volume=17 |issue=9 |pages=1015–20 |year=2002 |id=PMID 12167124}}</ref><ref>{{cite journal |author=Su C, Shyr Y, Lui W, P'Eng F |title=Hepatolithiasis associated with cholangiocarcinoma |journal=Br J Surg |volume=84 |issue=7 |pages=969-73 |year=1997 |id=PMID 9240138}}</ref><ref>{{cite journal |author=Donato F, Gelatti U, Tagger A, Favret M, Ribero M, Callea F, Martelli C, Savio A, Trevisi P, Nardi G |title=Intrahepatic cholangiocarcinoma and hepatitis C and B virus infection, alcohol intake, and hepatolithiasis: a case-control study in Italy |journal=Cancer Causes Control |volume=12 |issue=10 |pages=959-64 |year=2001 |id=PMID 11808716}}</ref> Exposure to [[Thorotrast]], a form of [[thorium dioxide]] which was used as a [[radiocontrast|radiologic contrast medium]], has been linked to the development of cholangiocarcinoma as late as 30–40 years after exposure; Thorotrast was banned in the United States in the 1950s due to its [[carcinogenicity]].<ref>{{cite journal |author=Sahani D, Prasad S, Tannabe K, Hahn P, Mueller P, Saini S |title=Thorotrast-induced cholangiocarcinoma: case report |journal=Abdom Imaging |volume=28 |issue=1 |pages=72-4 |year= |id=PMID 12483389}}</ref><ref>{{cite journal |author=Zhu A, Lauwers G, Tanabe K |title=Cholangiocarcinoma in association with Thorotrast exposure |journal=J Hepatobiliary Pancreat Surg |volume=11 |issue=6 |pages=430-3 |year=2004 |id=PMID 15619021}}</ref>
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| ==References== | | ==References== |
| {{reflist|2}} | | {{Reflist|2}} |
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| [[Category:Disease]]
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| [[Category:Rare cancers]]
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| [[Category:Rare diseases]]
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| [[Category:Types of cancer]]
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| [[Category:Hepatology]]
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| [[Category:Gastroenterology]]
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |
| | [[Category: (name of the system)]] |