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{{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]].
==Risk Factors==
==Risk Factors==
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). Epidemiologic studies have suggested that the lifetime risk of developing cholangiocarcinoma for a person with PSC is 10%&ndash;15%,<ref>Epidemiologic studies which have addressed the incidence of cholangiocarcinoma in people with primary sclerosing cholangitis include the following:
*Common risk factors in the development of cholangiocarcinoma include primary sclerosing cholangitis, fibropolycystic liver disease such as [[choledochal cysts]], [[hepatolithiasis]] and recurrent pyogenic [[cholangitis]].
*{{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}}
*{{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}}
*{{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.
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>


'''Chronic inflammation of the bile duct''':<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>
===Common Risk Factors===
*Primary sclerosing cholangitis (major risk factor in western countries)
*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>
*Recurrent pyogenic cholangitis (major risk factor in endemic areas)
**[[Primary sclerosing cholangitis]]
*Ulcerative colitis
**[[Cirrhosis]]
*Cholelithiasis
**Viral infections
*Cirrhosis
***[[HIV]]
'''Liver fluke infections''': Liver fluke infection is a major cause of cholangiocarcinoma in some Asian countries.<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>
***[[EBV]]
*Opisthorchis viverrini (found in Thailand, Laos, and Malaysia)
***[[Hepatitis]] viruses
*Clonorchis sinensis (found in Japan, Korea, and Vietnam)
****[[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


[[Image:Clonorchis sinensis LifeCycle.gif|thumb|left|150px|Life cycle of ''[[Clonorchis sinensis]]'', a [[liver fluke]] associated with cholangiocarcinoma]]
===Less Common Risk Factors===
'''Choledochal cysts''':
*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>
*Caroli's disease
**[[Thorotrast]]
'''Toxins''':<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>
**[[Diabetes]]
*Thorotrast(widely used as a contrast agent for x-rays until 1950s)
**[[Obesity]]
*Dioxin
**[[Alcohol]] consumption
*Polyvinyl chloride
**[[Smoking]]
*Heavy alcoholism
'''Viral infections''':<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>
*HIV
*Hepatitis B
*Hepatitis C
*EBV
'''Inherited disorders''':<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>
*Lynch syndrome II
*Biliary papillomatosis
'''Obesity'''
 
 
 
 
 
Certain [[parasitic disease|parasitic liver diseases]] may be risk factors as well. Colonization with the [[liver fluke]]s ''[[Opisthorchis viverrini]]'' or ''[[Clonorchis sinensis]]''  has been associated with the development of cholangiocarcinoma. Patients with chronic liver disease, whether in the form of viral hepatitis (e.g. [[hepatitis B]] or [[hepatitis C|C]]),[[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.
 
[[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. 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. 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]].


==References==
==References==
{{reflist|2}}
{{Reflist|2}}
 
[[Category:Disease]]
[[Category:Rare cancers]]
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[[Category:Types of cancer]]
[[Category:Hepatology]]
[[Category:Gastroenterology]]


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Latest revision as of 15:18, 12 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2], Suveenkrishna Pothuru, M.B,B.S. [3]

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.

Risk Factors

Common Risk Factors

Less Common Risk Factors

References

  1. ↑ Al-Bahrani R, Abuetabh Y, Zeitouni N, Sergi C (2013). "Cholangiocarcinoma: risk factors, environmental influences and oncogenesis". Ann. Clin. Lab. Sci. 43 (2): 195–210. PMID 23694797.
  2. ↑ Tyson GL, El-Serag HB (2011). "Risk factors for cholangiocarcinoma". Hepatology. 54 (1): 173–84. doi:10.1002/hep.24351. PMC 3125451. PMID 21488076.
  3. ↑ Ben-Menachem T (2007). "Risk factors for cholangiocarcinoma". Eur J Gastroenterol Hepatol. 19 (8): 615–7. doi:10.1097/MEG.0b013e328224b935. PMID 17625428.
  4. ↑ Gatto M, Alvaro D (2010). "Cholangiocarcinoma: risk factors and clinical presentation". Eur Rev Med Pharmacol Sci. 14 (4): 363–7. PMID 20496549.
  5. ↑ Acalovschi M (2004). "Cholangiocarcinoma: risk factors, diagnosis and management". Rom J Intern Med. 42 (1): 41–58. PMID 15529594.
  6. ↑ Razumilava N, Gores GJ (2013). "Classification, diagnosis, and management of cholangiocarcinoma". Clin. Gastroenterol. Hepatol. 11 (1): 13–21.e1, quiz e3–4. doi:10.1016/j.cgh.2012.09.009. PMC 3596004. PMID 22982100.

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