Cholangiocarcinoma risk factors: Difference between revisions
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==Overview== | ==Overview== | ||
==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%–15%,<ref>Epidemiologic studies which have addressed the incidence of cholangiocarcinoma in people with primary sclerosing cholangitis include the following: | |||
*{{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> | 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''': | '''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> | ||
*Primary sclerosing cholangitis (major risk factor in western countries) | *Primary sclerosing cholangitis (major risk factor in western countries) | ||
*Recurrent pyogenic cholangitis (major risk factor in endemic areas) | *Recurrent pyogenic cholangitis (major risk factor in endemic areas) | ||
*Ulcerative colitis | *Ulcerative colitis | ||
*Cholelithiasis | *Cholelithiasis | ||
*Cirrhosis | *Cirrhosis | ||
'''Liver fluke infections''': Liver fluke infection is a major cause of cholangiocarcinoma in some Asian countries. | '''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> | ||
*Opisthorchis viverrini | *Opisthorchis viverrini (found in Thailand, Laos, and Malaysia) | ||
*Clonorchis sinensis ( | *Clonorchis sinensis (found in Japan, Korea, and Vietnam) | ||
[[Image:Clonorchis sinensis LifeCycle.gif|thumb|left|150px|Life cycle of ''[[Clonorchis sinensis]]'', a [[liver fluke]] associated with cholangiocarcinoma]] | |||
'''Choledochal cysts''': | '''Choledochal cysts''': | ||
*Caroli's disease | *Caroli's disease | ||
'''Toxins''': | '''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> | ||
*Thorotrast(widely used as a contrast agent for x-rays until 1950s) | *Thorotrast(widely used as a contrast agent for x-rays until 1950s) | ||
*Dioxin | *Dioxin | ||
*Polyvinyl chloride | *Polyvinyl chloride | ||
*Heavy alcoholism | *Heavy alcoholism | ||
'''Viral infections''': | '''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 | *HIV | ||
*Hepatitis B | *Hepatitis B | ||
*Hepatitis C | *Hepatitis C | ||
*EBV | *EBV | ||
'''Inherited disorders''': | '''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 | *Lynch syndrome II | ||
*Biliary papillomatosis | *Biliary papillomatosis | ||
'''Obesity''' | '''Obesity''' | ||
[[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. | |||
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== | ||
Revision as of 18:32, 30 October 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Risk Factors
A number of risk factors 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%–15%,[1] 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.[2]
Chronic inflammation of the bile duct:[3]
- Primary sclerosing cholangitis (major risk factor in western countries)
- Recurrent pyogenic cholangitis (major risk factor in endemic areas)
- Ulcerative colitis
- Cholelithiasis
- Cirrhosis
Liver fluke infections: Liver fluke infection is a major cause of cholangiocarcinoma in some Asian countries.[4][5][6]
- Opisthorchis viverrini (found in Thailand, Laos, and Malaysia)
- Clonorchis sinensis (found in Japan, Korea, and Vietnam)
Choledochal cysts:
- Caroli's disease
- Thorotrast(widely used as a contrast agent for x-rays until 1950s)
- Dioxin
- Polyvinyl chloride
- Heavy alcoholism
- HIV
- Hepatitis B
- Hepatitis C
- EBV
- Lynch syndrome II
- Biliary papillomatosis
Obesity
Certain parasitic liver diseases may be risk factors as well. Colonization with the liver flukes 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 C),alcoholic liver disease, or cirrhosis from other causes, are at increased risk of cholangiocarcinoma.[14] 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 liver abnormalities, such as Caroli's syndrome or choledochal cysts, have been associated with an approximately 15% lifetime risk of developing cholangiocarcinoma.[15][16] The rare inherited disorders 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 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
- ↑ Epidemiologic studies which have addressed the incidence of cholangiocarcinoma in people with primary sclerosing cholangitis include the following:
- 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 (2002). "Hepatic and extrahepatic malignancies in primary sclerosing cholangitis". J Hepatol. 36 (3): 321–7. PMID 11867174.
- Bergquist A, Glaumann H, Persson B, Broomé U (1998). "Risk factors and clinical presentation of hepatobiliary carcinoma in patients with primary sclerosing cholangitis: a case-control study". Hepatology. 27 (2): 311–6. PMID 9462625.
- Burak K, Angulo P, Pasha T, Egan K, Petz J, Lindor K (2004). "Incidence and risk factors for cholangiocarcinoma in primary sclerosing cholangitis". Am J Gastroenterol. 99 (3): 523–6. PMID 15056096.
- ↑ Cholangiocarcinoma. Radiopaedia. http://radiopaedia.org/articles/cholangiocarcinoma
- ↑ Chapman R. "Risk factors for biliary tract carcinogenesis". Ann Oncol. 10 Suppl 4: 308–11. PMID 10436847.
- ↑ Watanapa P (1996). "Cholangiocarcinoma in patients with opisthorchiasis". Br J Surg. 83 (8): 1062–64. PMID 8869303.
- ↑ Watanapa P, Watanapa W (2002). "Liver fluke-associated cholangiocarcinoma". Br J Surg. 89 (8): 962–70. PMID 12153620.
- ↑ Shin H, Lee C, Park H, Seol S, Chung J, Choi H, Ahn Y, Shigemastu T (1996). "Hepatitis B and C virus, Clonorchis sinensis for the risk of liver cancer: a case-control study in Pusan, Korea". Int J Epidemiol. 25 (5): 933–40. PMID 8921477.
- ↑ Sahani D, Prasad S, Tannabe K, Hahn P, Mueller P, Saini S. "Thorotrast-induced cholangiocarcinoma: case report". Abdom Imaging. 28 (1): 72–4. PMID 12483389.
- ↑ Zhu A, Lauwers G, Tanabe K (2004). "Cholangiocarcinoma in association with Thorotrast exposure". J Hepatobiliary Pancreat Surg. 11 (6): 430–3. PMID 15619021.
- ↑ Kobayashi M, Ikeda K, Saitoh S, Suzuki F, Tsubota A, Suzuki Y, Arase Y, Murashima N, Chayama K, Kumada H (2000). "Incidence of primary cholangiocellular carcinoma of the liver in Japanese patients with hepatitis C virus-related cirrhosis". Cancer. 88 (11): 2471–7. PMID 10861422.
- ↑ Yamamoto S, Kubo S, Hai S, Uenishi T, Yamamoto T, Shuto T, Takemura S, Tanaka H, Yamazaki O, Hirohashi K, Tanaka T (2004). "Hepatitis C virus infection as a likely etiology of intrahepatic cholangiocarcinoma". Cancer Sci. 95 (7): 592–5. PMID 15245596.
- ↑ Lu H, Ye M, Thung S, Dash S, Gerber M (2000). "Detection of hepatitis C virus RNA sequences in cholangiocarcinomas in Chinese and American patients". Chin Med J (Engl). 113 (12): 1138–41. PMID 11776153.
- ↑ Mecklin J, Järvinen H, Virolainen M (1992). "The association between cholangiocarcinoma and hereditary nonpolyposis colorectal carcinoma". Cancer. 69 (5): 1112–4. PMID 1310886.
- ↑ Lee S, Kim M, Lee S, Jang S, Song M, Kim K, Kim H, Seo D, Song D, Yu E, Lee S, Min Y (2004). "Clinicopathologic review of 58 patients with biliary papillomatosis". Cancer. 100 (4): 783–93. PMID 14770435.
- ↑ Sorensen H, Friis S, Olsen J, Thulstrup A, Mellemkjaer L, Linet M, Trichopoulos D, Vilstrup H, Olsen J (1998). "Risk of liver and other types of cancer in patients with cirrhosis: a nationwide cohort study in Denmark". Hepatology. 28 (4): 921–5. PMID 9755226.
- ↑ Lipsett P, Pitt H, Colombani P, Boitnott J, Cameron J (1994). "Choledochal cyst disease. A changing pattern of presentation". Ann Surg. 220 (5): 644–52. PMID 7979612.
- ↑ Dayton M, Longmire W, Tompkins R (1983). "Caroli's Disease: a premalignant condition?". Am J Surg. 145 (1): 41–8. PMID 6295196.