Differentiating cholangiocarcinoma from other diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Cancerous tumors of the bile ducts are usually slow-growing and do not spread (metastasize) quickly. However, many of these tumors are already advanced by the time they are found.

A cholangiocarcinoma may start anywhere along the bile ducts. These tumors block off the bile ducts.

They affect both men and women. Most patients are older than 65.

Diseases with similar symptoms

Differential diagnosis is different according to whether the tumour is intra or extrahepatic and depending on the growth pattern. For an intrahepatic mass-forming cholangiocarcinoma consider:

• Liver metastases

• Central necrosis (high T2 signal) is more common

• Hepatocellular carcinoma (HCC)

• Tumor thrombus more common
• Capsular retraction uncommon
• May appear very similar

• Other primary liver tumors
• Hepatic abscess

For a periductal infiltrating cholangiocarcinoma consider:

• Benign stricture

• Usually short-segment
• Regular margin
• Symmetric narrowing
• No ductal enhancement
• No lymph node enlargement
• No periductal soft-tissue mass

• Periportal lymphangitic metastasis

For an intraductal cholangiocarcinoma consider:

• Intraductal invasion by a HCC

• Extraductal mass

• Hepatolithiasis

• No enhancement
• Higher attenuation

• Biliary cystadenoma or cystadenocarcinoma

• Intratumoural cysts do not communicate with the biliary tree

• Benign stricture

Other health problems may also cause similar symptoms. Diseases with similar symptoms are listed in the following:

• Gallbladder cancer

• Hepatocellular Carcinoma

• Pancreatic cancer

• Cholecystitis and choledochitis

• Liver fluke infections