Biliary Strictures and Cholangiocarcinoma – Untangling a Diagnostic Conundrum

Abstract

Cholangiocarcinoma is an uncommon and highly aggressive biliary tract malignancy with few manifestations until late disease stages. Diagnosis is currently achieved through a combination of clinical, biochemical, radiological and histological techniques. A number of reported cancer biomarkers have the potential to be incorporated into diagnostic pathways, but all lack sufficient sensitivity and specificity limiting their possible use in screening and early diagnosis. The limitations of standard serum markers such as CA19-9, CA125 and CEA have driven researchers to identify multiple novel biomarkers, yet their clinical translation has been slow with a general requirement for further validation in larger patient cohorts. We review recent advances in the diagnostic pathway for suspected CCA as well as emerging diagnostic biomarkers for early detection, with a particular focus on non-invasive approaches.

Prognostic and recurrent significance of SII in patients with pancreatic head cancer undergoing pancreaticoduodenectomy

“…However, there is no good predictive method for the prognosis of these high-risk PHC with venous invasion, especially lack of preoperative noninvasive predictive indicators. Most patients with PHC had jaundice or cholangitis, accounting for 54% of jaundice in our cohort, which may have contributed to the low predictive efficacy of carbohydrate antigen19-9 (CA19-9) ( 8 ). Pathologic evaluation is the gold standard for predicting prognosis, but it can only be properly evaluated postoperatively.…”

Prognostic influence for hilar cholangiocarcinoma and comparisons of prognostic values of Mayo staging and TNM staging systems

“…The diagnosis was in the middle and late stages. [43][44][45] Therefore, the cohort study is concentrated on stage III and is also reasonable. We used the comparison of the area under the ROC when evaluating the two staging systems in our research, showing the discrimination and single trend of the two staging systems.…”

“…The diagnosis was in the middle and late stages. [43–45] Therefore, the cohort study is concentrated on stage III and is also reasonable.…”

Case report: The diagnostic dilemma of indeterminate biliary strictures: report on two cases with a literature review

“…The highly aggressive CCA, arising from the bile duct epithelium, constitutes the second most frequent cause of MBSs. CCA can be classified into intrahepatic, perihilar, or distal types, with perihilar cases accounting for 60 to 70% of occurrences ( 5 ). Initially, patients with CCA are usually asymptomatic.…”

“…Up to 15% of patients with PSC will develop CCA, with the highest incidence 2-5 years into diagnosis ( 6 ). Unfortunately, CCAs are marked by poor prognoses, with an overall five-year survival rate of less than 20% ( 5 ).…”