Diagnostic-therapeutic management of bile duct cancer

Abstract

Biliary tract cancer, or cholangiocarcinoma, comprises a heterogeneous group of malignant tumors that can emerge at any part of the biliary tree. This group is the second most common type of primary liver cancer. Diagnosis is usually based on symptoms, which may be heterogeneous, and nonspecific biomarkers in serum and biopsy specimens, as well as on imaging techniques. Endoscopy-based diagnosis is essential, since it enables biopsy specimens to be taken. In addition, it can help with locoregional staging of distal tumors. Endoscopic retrograde cholangiopancreatography is a key technique for the evaluation and treatment of malignant biliary tumors. Correct staging of cholangiocarcinoma is essential in order to be able to determine the degree of resectability and assess the results of treatment. The tumor is staged based on the TNM classification of the American Joint Committee on Cancer. The approach will depend on the classification of the tumor. Thus, some patients with early-stage disease could benefit from surgery; complete surgical resection is the cornerstone of cure. However, only a minority of patients are diagnosed in the early stages and are suitable candidates for resection. In the subset of patients diagnosed with locally advanced or metastatic disease, chemotherapy has been used to improve outcome and to delay tumor progression. The approach to biliary tract tumors should be multidisciplinary, involving experienced endoscopists, oncologists, radiologists, and surgeons.

Patient-derived tumor xenograft and organoid models established from resected pancreatic, duodenal and biliary cancers

“…The molecular landscapes of these cancers show diverse abnormalities in sustained tumor growth, cell cycle and cell signaling pathways that may influence disease resistance to systemic and targeted therapies 3 – 5 . There are no validated biomarkers to assess individual tumor susceptibility to such targeted or systemic therapies in these cancers besides targeting DNA repair factors with poly-ADP ribose polymerase inhibitors in Pancreatic Ductal Adenocarcinoma (PDAC) harboring germline BRCA mutations 6 – 9 .…”

Patient-derived Tumor Xenograft and Organoid Models Established from Resected Pancreatic, Duodenal and Biliary Cancers

“…The molecular landscapes of these cancers show diverse abnormalities in sustained tumor growth, cell cycle and cell signaling pathways that may influence disease resistance to systemic and targeted therapies (3)(4)(5). There are no validated biomarkers to assess individual tumor susceptibility to such targeted or systemic therapies in these cancers besides targeting DNA repair factors with poly-ADP ribose polymerase inhibitors in Pancreatic Ductal Adenocarcinoma (PDAC) harboring germline BRCA mutations (6)(7)(8)(9). PDAC is the most common and widely characterized periampullary cancer.…”

The New Era of Immunotherapy in Bile Duct Cancer Management

“…The clinical features of CCA are heterogenous, with general malaise, cachexia, abdominal pain, night sweats, fatigue, weight loss, asthenia, and/or jaundice which is more frequent symptom in pCCA and dCCA due to biliary tract obstruction. [23,24] Diagnosis of CCA is usually confirmed by combining nonspecific biomarkers in serum, biopsy specimens, and imaging technique. To date, there is no specific serum marker available for diagnosing CCA.…”

“…[33,34] Criteria for patients who are considered as absolute unresectability are the presence of nonresectable extrahepatic, hepatic metastases, bilateral extension of the tumor with involvement of the secondary biliary tract, complete occlusion of the main portal vein, thrombosis in portal vein contralateral to the tumor. [23] The most common postoperative complications are hemorrhage, infection, liver failure, cardiorespiratory failure, and adrenal failure. Mortality and morbidity for postoperative patient are still remaining high, 8,2% and 50%, respectively.…”