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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.
*{{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.


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 name="riskfactors"/><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.<ref name="riskfactors"/>
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.


[[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>
[[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>

Revision as of 01:25, 27 July 2012

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

Overview

Risk Factors

Life cycle of Clonorchis sinensis, a liver fluke associated with cholangiocarcinoma

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).[1] Epidemiologic studies have suggested that the lifetime risk of developing cholangiocarcinoma for a person with PSC is 10%–15%,[2] 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.

Certain parasitic liver diseases may be risk factors as well. Colonization with the liver flukes 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.[3][4][5] Patients with chronic liver disease, whether in the form of viral hepatitis (e.g. hepatitis B or C),[6][7][8] alcoholic liver disease, or cirrhosis from other causes, are at increased risk of cholangiocarcinoma.[9] 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.[10][11] The rare inherited disorders Lynch syndrome II and biliary papillomatosis are associated with cholangiocarcinoma.[12][13] 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.[14][15][16] 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.[17][18]

References

  1. ↑ Chapman R. "Risk factors for biliary tract carcinogenesis". Ann Oncol. 10 Suppl 4: 308–11. PMID 10436847.
  2. ↑ 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.
  3. ↑ Watanapa P (1996). "Cholangiocarcinoma in patients with opisthorchiasis". Br J Surg. 83 (8): 1062–64. PMID 8869303.
  4. ↑ Watanapa P, Watanapa W (2002). "Liver fluke-associated cholangiocarcinoma". Br J Surg. 89 (8): 962–70. PMID 12153620.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ Dayton M, Longmire W, Tompkins R (1983). "Caroli's Disease: a premalignant condition?". Am J Surg. 145 (1): 41–8. PMID 6295196.
  12. ↑ Mecklin J, Järvinen H, Virolainen M (1992). "The association between cholangiocarcinoma and hereditary nonpolyposis colorectal carcinoma". Cancer. 69 (5): 1112–4. PMID 1310886.
  13. ↑ 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.
  14. ↑ Lee C, Wu C, Chen G (2002). "What is the impact of coexistence of hepatolithiasis on cholangiocarcinoma?". J Gastroenterol Hepatol. 17 (9): 1015–20. PMID 12167124.
  15. ↑ Su C, Shyr Y, Lui W, P'Eng F (1997). "Hepatolithiasis associated with cholangiocarcinoma". Br J Surg. 84 (7): 969–73. PMID 9240138.
  16. ↑ Donato F, Gelatti U, Tagger A, Favret M, Ribero M, Callea F, Martelli C, Savio A, Trevisi P, Nardi G (2001). "Intrahepatic cholangiocarcinoma and hepatitis C and B virus infection, alcohol intake, and hepatolithiasis: a case-control study in Italy". Cancer Causes Control. 12 (10): 959–64. PMID 11808716.
  17. ↑ 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.
  18. ↑ Zhu A, Lauwers G, Tanabe K (2004). "Cholangiocarcinoma in association with Thorotrast exposure". J Hepatobiliary Pancreat Surg. 11 (6): 430–3. PMID 15619021.

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