Malignity žlučových cest
:
Š. Tuček 1,2; J. Tomášek 1,2; J. Halámková 1; I. Kiss 1,2; T. Andrašina 3; B. Hemmelová 4; D. Adámková‑ krákorová 2; R. Vyzula 1,2
:
Department of Clinical Oncology, Faculty Hospital Brno
1; Masaryk Memorial Cancer Institute, Brno
2; Department of Radiology, Faculty Hospital Brno
3; Department of Surgery, Faculty Hospital Brno
4
:
Klin Onkol 2010; 23(4): 231-241
:
Reviews
Malignity žlučových cest zahrnují intra‑ a extrahepatální cholangiokarcinomy, karcinom žlučníku a karcinom Vaterské papily. Jsou to vzácné nádory s celkově špatnou prognózou. Incidence dosahuje 12,5/ 100 tis. obyvatel a mortalita 9,5/ 100 tis. obyvatel, obojí byly v posledních 30 letech pozoruhodně stabilní. Celkové přežití pacientů s těmito nádory je žalostné, většinou do 12 měsíců. Diagnostika má různá úskalí a velmi často přichází pozdě. Většina případů je při diagnóze neoperabilních, proto je zde hlavní modalitou paliativní léčba. Ta je však stále problematická, nové postupy mnoho nepřinesly. Chybí standardy paliativní péče a hodnocení kvality života je překvapivě velmi málo časté. I z nečetných dat se zdá být zřejmý pozitivní efekt multimodální individualizované léčby na přežití a kvalitu života pacientů. Ve specializovaných centrech zahrnují léčebné možnosti metody chirurgické, intervenční radiologii, klinickou onkologii a metody kvalitní podpůrné péče. Tyto metody jsou rozebírány v článku podrobněji. Zlepšení lze očekávat od nových diagnostických metod a nových postupů v chirurgii a intervenční radiologii. Také lepší poznání biologie nádorů na molekulární úrovni snad přinese více vyléčených pacientů. V paliativní léčbě lze zlepšení očekávat v nalezení nových cílových struktur a vývoji nových léčiv. Malé počty pacientů jsou limitující pro jakýkoli pokrok v tomto odvětví. Lze doufat, že nový volnější design mezinárodních randomizovaných multicentrických studií s pružným sdílením dat tento hlavní problém překlene. Nezbytným dalším krokem je definice standardů paliativní péče a hodnocení kvality života přinese pohled na skutečný přínos paliativní léčby pro pacienty.
Klíčová slova:
nádory žlučových cest – cholangiokarcinom – nádory žlučníku – paliativní terapie
Sources
1. Carriaga MT, Henson DE. Liver, gallbladder, extrahepatic bile ducts, and pancreas. Cancer 1995; 75 (Suppl 1): 171– 190.
2. Jarnagin W. Cholangiocarcinoma of the extrahepatic bile ducts. Sem Surg Oncol 2000; 19(2): 156– 176.
3. Cancer Incidence in the Czech Republic 2006 [pdf file]. Available from: www.uzis.cz.
4. Wotke J, Foukal T. Korelace klinické bioptické diagnózy karcinomu žlučníku. Klin Onkol 1994; 7(4): 117– 119.
5. Patel T. Worldwide trends in mortality from biliary tract malignancies. BMC Cancer 2002; 2: 10.
6. Holzinger F, Z‘graggen K, Buchler MW. Mechanisms of biliary carcinogenesis: A pathogenetic multi‑stage cascade towards cholangiocarcinoma. Ann Oncol 1999; 10 (Suppl 4): 122– 126.
7. Park J, Tadlock L, Gores GJ et al. Inhibition of interleukin 6– mediated mitogen‑activated protein kinase activation attenuates growth of a cholangiocarcinoma cell line. Hepatology 1999; 30: 1128– 1133.
8. Que FG, Phan VA, Phan VH et al. Cholangiocarcinomas express Fas ligand and disable the Fas receptor. Hepatology 1999; 30: 1398– 1404.
9. Yee K, Sheppard BC, Domreis J et al. Cancers of the gallbladder and biliary ducts. Oncology (Williston Park) 2002; 16(7): 939– 946, 949.
10. Sandhu DS, Roberts LR. Diagnosis and management of cholangiocarcinoma. Curr Gastroenterol Rep 2008; 10(1): 43– 52.
11. Parkin DM, Ohshima H, Srivatanakul P et al. Cholangiocarcinoma: epidemiology, mechanisms of carcinogenesis and prevention. Cancer Epidemiol Biomarkers Prev 1993; 2(6): 537– 544.
12. 41. Klener P et al. Klinická onkologie. Praha: Galén 2002: 421– 422.
13. Yamamoto S, Kubo S, Hai S et al. Hepatitis C virus infection as a likely etiology of intrahepatic cholangiocarcinoma. Cancer Sci 2004; 95(7): 592– 595.
14. Dutta U, Garg PK, Kumar R. Typhoid carriers among patients with gallstones are at increased risk for carcinoma of the gallbladder. Am J Gastroenterol 2000; 95(3): 784– 787.
15. de Bree E, Tsiftsis DD, Santos RM et al. Objective assessment of the contribution of each diagnostic test and of the ordering sequence in jaundice caused by pancreatobiliary carcinoma. Scand J Gastroenterol 2000; 35(4): 438– 445.
16. Broden G, Bengtsson L. Biliary carcinoma associated with methyldopa therapy. Acta Chir Scand 1980; 500: 7.
17. Ellis EF, Gordon PR, Gottlieb LS. Oral contraceptives and cholangiocarcinoma. Lancet 1978; 1(8057): 207.
18. Lowenfels AB, Norman J. Isoniazid and bile duct cancer. JAMA 1978; 240(5): 434– 435.
19. Mancuso TF, Brennan MJ. Epidemiological considerations of cancer of the gallbladder, bile ducts and salivary glands in the rubber industry. J Occup Med 1970; 12(9): 333– 341.
20. Kowalewski K, Todd EF. Carcinoma of the gallbladder induced in hamsters by insertion of cholesterol pellets and feeding dimethylnitrosamine. Proc Soc Exp Biol Med 1971; 136(2): 482– 486.
21. Harder J, Blum HE. Cholangiocarcinoma. Schweiz Rundsch Med Prax 2002; 91(34): 1352– 1356.
22. Epidemiology of malignant tumours in the Czech Republic [website]. [Cited Sept 15, 2009]. Available from: www.svod.cz.
23. Fleming J, Cooper J, Henson D et al (eds). Gallbladder and extrahepatic bile ducts. AJCC Cancer Staging Handbook. Philadelphia: Lippincott‑ Raven 1998; 97– 106.
24. Nakeeb A, Pitt HA, Sohn TA et al. Cholangiocarcinoma: a spectrum of intrahepatic perihilar, and distal tumours. Ann Surg 1996; 224(4): 463– 473.
25. Válek V, Kala Z, Kiss I. Úskalí v diagnostice a léčbě onemocnění HPB. Zobrazovací vyšetření – senzitivita a specificita. Edukační sborník XXVIII. Brněnské onkologické dny. Brno 2004: 162– 166.
26. Hann LE, Greatrex KV, Bach AM et al. Cholangiocarcinoma at the hepatic hilus: sonographic findings. Am J Roentgenol 1997; 168(4): 985– 989.
27. Bach AM, Hann LE, Brown KT et al. Portal vein evaluation with US: comparison to angiography combined with CT arterial protography. Radiology 1996; 201(1): 149– 154.
28. Bohatá Š. Přínos kontrastního ultrazvukového vyšetření v diferenciální diagnostice ložiskových procesů jater. Doktorandská dizertační práce. Brno: LF MU 2009.
29. Loyer EM, Chin H, DuBrow RA et al. Hepatocellular carcinoma and intrahepatic peripheral cholangiocarcinoma: enhancement patterns with quadruple phase helical CT – a comparative study. Radiology 1999; 212(3): 866– 875.
30. Lopera JE, Soto JA, Múnera F. Malignant Hilar and Perihilar Biliary Obstruction: Use of MR cholangiography to define the extent of biliary ductal involvement and plan percutaneous interventions. Radiology 2001; 220: 90– 96.
31. Campbell WL, Ferris JV, Holbert BL et al. Biliary tract carcinoma complicating primary sclerosing cholangitis: Evaluation with CT, cholangiography, US, and MR imaging. Radiology 1998; 207(1): 41– 50.
32. Hochwald SN, Burke EC, Jarnagin WR et al. Association of preoperative biliary stenting with increased postoperative infectious complications in proximal cholangiocarcinoma. Arch Surg 1998; 134(3): 261– 266.
33. Otto G, Romaneehsen B, Hoppe‑ Lotichius M et al. Hilar cholangiocarcinoma: resectability and radicality after routine diagnostic imaging. J Hepatobiliary Pancreat Surg 2004; 11(5): 310– 318.
34. Torok N, Gores GJ. Cholangiocarcinoma. Semin Gastrointest Dis 2001; 12(2): 125– 132.
35. Van Beers BE. Diagnosis of cholangiocarcinoma. Oxford: HPB 2008; 10(2): 87– 93.
36. Petrowsky H, Wildbrett P, Husarik DB et al. Impact of integrated positron emission tomography and computed tomography on staging and management of gallbladder cancer and cholangiocarcinoma. J Hepatol 2006; 45(1): 43– 50. Epub 2006 Apr 19.
37. Kluge R, Schmidt F, Caca K et al. Positron emission tomography with [(18)F]fluoro‑2- deoxy‑ D‑ glucose for diagnosis and staging of bile duct cancer. Hepatology 2001; 33(5): 1029– 1035.
38. Carr TG, Kazarian KK, Smego DR et al. Radionuclide cholescintigraphy in patients with suspected biliary tract obstruction. Am Surg 1991; 57(10): 673– 675.
39. Poneros JM, Tearney GJ, Shiskov M et al. Optical coherence tomography of the biliary tree during ERCP. Gastrointest Endosc 2002; 55(1): 84– 88.
40. Singh P, Chak A, Willis JE et al. In vivo optical coherence tomography imaging of the pancreatic and biliary ductal system. Gastrointest Endosc 2005; 62(6): 970– 974.
41. Gores GJ. Early detection and treatment of cholangiocarcinoma. Liver Transpl 2000; 6(6 Suppl 2): 30– 34.
42. Huang JL, Biehl TR, Lee FT et al. Outcomes after resection of cholangiocellular carcinoma. Am J Surg 2004; 187(5): 612– 617.
43. Shimada M, Takenaka K, Kawahara N et al. Chemosensitivity in primary liver cancers: evaluation of the correlation between chemosensitivity and clinicopathological factors. Hepatogastroenterology 1996; 43(11): 1159– 1164.
44. Marrelli D, Caruso S, Pedrazzani C et al. CA19- 9 serum levels in obstructive jaundice: clinical value in benign and malignant conditions. Am J Surg 2009; 198(3): 333– 339. Epub 2009 Apr 17.
45. Bedi MM, Gandhi MD, Jacob G et al. CA 19- 9 to differentiate benign and malignant masses in chronic pancreatitis: is there any benefit? Indian J Gastroenterol 2009; 28(1): 24– 27. Epub 2009 Jun 6.
46. Aljiffry M, Walsh MJ, Molinari M. Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990– 2009. World J Gastroenterol 2009; 15(34): 4240– 4262.
47. Tompkins RK, Thomas D, Wile A et al. Prognostic factors in bile duct carcinoma. Analysis of 96 cases. Ann Surg 1981; 194(4): 447– 457.
48. Wade TP, Prasad CN, Virgo KS et al. Experience with distal bile duct cancers in U.S. Veterans Affairs hospitals: 1987– 1991. J Surg Oncol 1997; 64(3): 242– 245.
49. Okuda K, Kubo Y, Okazaki N et al. Clinical aspects of intrahepatic bile duct carcinoma including hilar carcinoma. A study of 57 autopsy‑ proven cases. Cancer 1977; 39(1): 232– 246.
50. Sako S, Seitzinger GL, Garside E. Carcinoma of the extrahepatic bile ducts. Review of the literature and report of six cases. Surgery 1957; 41(37): 416– 437.
51. Burke EC, Jarnagin WR, Hochwald SN et al. Hilar cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system. Ann Surg 1998; 228(3): 385– 394.
52. Donohue JH, Stewart AK, Menck HR. The national Cancer Data Base report on carcinoma of the gallbladder, 1989– 1995. Cancer 1998; 83(12): 2618– 2628.
53. Duffy A, Capanu M, Abou‑ Alfa GK et al. Gallbladder cancer (GBC): 10‑year experience at Memorial Sloan‑ Kettering Cancer Centre (MSKCC). J Surg Oncol 2008; 98(7): 485– 489.
54. DeVita VT Jr, Hellman S, Rosenberg SA (eds). Cancer, Principles & Practice of Oncology. 7th ed. Philadelphia: Lippincott Williams and Wilkins Publishers 2004; CD‑ ROM Chapter 29: Sec 5.
55. Jemal A, Tiwari RC, Murray T et al. American Cancer Society. Cancer statistics, 2004. CA Cancer J Clin 2004; 54(1): 8– 29.
56. Fong Y, Kemeny N, Lawrence TS. Cancer of the Liver and Biliary Tree. In: DeVita VT Jr, Hellman S, Rosenberg SA (eds). Cancer, Principles & Practice of Oncology. 6th ed. Philadelphia: Lippincott Williams and Wilkins Publishers 2001: 1162– 1203.
57. De Aretxabala X, Roa I, Araya JC et al. Gallbladder cancer in Chile. A report on 54 potentially resectable tumors. Cancer 1992, 69(1): 60– 65.
58. De Groen PC, Gores GJ, LaRusso NF et al. Biliary Tract Cancers. N Engl J Med 1999; 341(18): 1368– 1378.
59. De Vita VT Jr, Hellman S, Rosenberg SA (eds). Cancer, Principles & Practice of Oncology. 7th ed. Philadelphia: Lippincott Williams and Wilkins Publishers 2005: 1021.
60. Choi CW, Choi IK, Seo JH et al. Effects of 5– fluorouracil and leucovorin in the treatment of pancreatic‑ biliary tract adenocarcinomas. Am J Clin Oncol 2000; 23(4): 425– 428.
61. Chen H, Hardacre JM, Uzar A et al. Isolated liver metastases from neuroendocrine tumours: does resection prolong survival? J Am Coll Surg 1998; 187(1): 88– 92.
62. Bucher P, Chassot G, Durmishi Y et al. Long‑term results of surgical treatment of Vater’s ampulla neoplasms. Hepatogastroenterology 2007; 54(76): 1239– 1242.
63. Shirabe K, Shimada M, Harimoto N et al. Intrahepatic cholangiocarcinoma: its mode of spreading and therapeutic modalities. Surgery 2002; 131(1 Suppl): 159– 164.
64. Fong Y, Blumgart LH, Lin E et al. Outcome of treatment for distal bile duct cancer. Br J Surg 1996; 83(12): 1712– 1715.
65. Novotný J et al. C24 Zhoubný novotvar jiných a neurčených částí žlučových cest [website]. [cited June 6, 2009]. Available from www.koc.cz.
66. Li S, Jo YS, Lee JH et al. L1 cell adhesion molecule is a novel independent poor prognostic factor of extrahepatic cholangiocarcinoma. Clin Cancer Res 2009; 15(23): 7345– 7351. Epub 2009 Nov 17.
67. Karamitopoulou E, Tornillo L, Zlobec I et al. Clinical significance of cell cycle – and apoptosis‑related markers in biliary tract cancer: a tissue microarray‑based approach revealing a distinctive immunophenotype for intrahepatic and extrahepatic cholangiocarcinomas. Am J Clin Pathol 2008; 130(5): 780– 786.
68. Alvaro D. Serum and bile biomarkers for cholangiocarcinoma. Curr Opin Gastroenterol 2009; 25(3): 279– 284.
69. Malouf G, Dreyer C, Guedj N et al. Prognosis factors of cholangiocarcinoma: contribution of recent molecular biology tools. Bull Cancer 2009; 96(4): 405– 415.
70. NCCN Practice Guidelines in Oncology [website], Hepatobiliary Cancers. [cited January 5, 2010]. Available from www.nccn.org.
71. Meyer CG, Penn I, James L. Liver transplantation for cholangiocarcinoma: Results in 207 patients. Transplantation 2000; 69(8): 1633– 1637.
72. Heneghan MA, Tuttle‑ Newhall JE, Suhocki PV et al. De‑ novo cholangiocarcinoma in the setting of recurrent primary sclerosing cholangitis following liver transplant. Am J Transplant 2003; 3(5): 634– 638.
73. Rea DJ, Rosen CB, Nagorney DM et al. Transplantation for cholangiocarcinoma: when and for whom? Surg Oncol Clin N Am 2009; 18(2): 325– 337, ix.
74. McMasters KM, Tuttle TM, Leach SD et al. Neoadjuvant chemoradiation for extrahepatic cholangiocarcinoma. Am J Surg 1997; 174(6): 605– 608.
75. Freeman ML, Sielaff TD. A modern approach to malignant hilar biliary obstruction. Rev Gastroenterol Disord 2003; 3(4): 187– 201.
76. Prat F, Lafon C, De Lima DM et al. Endoscopic treatment of cholangiocarcinoma and carcinoma of the duodenal papilla by intraductal high‑intensity US: Results of a pilot study. Gastrointest Endosc 2002; 56(6): 909– 915.
77. Burger I, Hong K, Schulick R et al. Transcatheter arterial chemoembolization in unresectable cholangiocarcinoma: initial experience in a single institution. J Vasc Interv Radiol 2005; 16(3): 353– 361.
78. Hidaka H, Kokubu S, Ono K. Radiofrequency ablation. Gan To Kagaku Ryoho 2001; 28(13): 1955– 1961.
79. Bachar GN, Greif F, Mor E et al. Radiofrequency ablation for the management of liver tumours. Isr Med Assoc J 2003; 5(7): 496– 500.
80. Siperstein A, Garland A, Engle K et al. Laparoscopic radiofrequency ablation of primary and metastatic liver tumours. Technical considerations. Surg Endosc 2000; 14(4): 400– 405.
81. Martin R, Jarnagin W. Intrahepatic cholangiocarcinoma. Current management. Minerva Chir 2003; 58(4): 469– 478.
82. Jarnagin WR, Ruo L, Little SA et al. Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma: implications for adjuvant therapeutic strategies. Cancer 2003; 98(8): 1689– 1700.
83. Yalcin S. Diagnosis and management of cholangiocarcinomas: a comprehensive review. Hepatogastroenterology 2004; 51(55): 43– 50.
84. Scheithauer W. Review of gemcitabine in biliary tract carcinoma. Semin Oncol 2002; 29(6 Suppl 20): 40– 45.
85. Hezel AF, Zhu AX. Systemic Therapy for Biliary Tract Cancers. Oncologist 2008; 13(4); 415– 423.
86. Melichar B, Cerman J Jr, Dvorak J et al. Regional chemotherapy in biliary tract cancers – a single institution experience. Hepatogastroenterology 2002; 49(46): 900– 906.
87. Andrýsek O, Horák H, Linhart L et al. Naše výsledky kombinované systémové a intraarteriální chemoterapie jaterních metastáz kolorektálního karcinomu a karcinomu žlučových cest. Klin Onkol 1988; 1(4): 98– 101.
88. Lersch C, Classen M. Palliative therapy of carcinomas of the biliary system. Med Klin (Munich) 1997; 92(7): 401– 405.
89. Bosset JF, Mantion G, Gillet M et al. Primary carcinoma of the gallbladder. Adjuvant postoperative external irradiation. Cancer 1989; 64(9): 1843– 1847.
90. de Aretxabala X, Roa I, Burgos L et al. Preoperative chemoradiotherapy in the treatment of gallbladder cancer. Am Surg 1999; 65(3): 241– 246.
91. Macdonald OK, Crane CH. Palliative and postoperative radiotherapy in biliary tract cancer. Surg Oncol Clin N Am 2002; 11(4): 941– 954.
92. Czito BG, Anscher MS, Willett CG. Radiation therapy in the treatment of cholangiocarcinoma. Oncology (Williston Park) 2006; 20(8): 873– 884.
93. Saito H, Takada T, Miyazaki M et al. Japanese Association of Biliary Surgery; Japanese Society of Hepato‑ Biliary‑ Pancreatic Surgery; Japan Society of Clinical Oncology. Radiation therapy and photodynamic therapy for biliary tract and ampullary carcinomas. J Hepatobiliary Pancreat Surg 2008; 15(1): 63– 8. Epub 2008 Feb 16.
94. Zhai R, Qian X, Dai D et al. Malignant biliary obstruction: treatment with interventional radiology. Chin Med J (Engl) 2003; 116(6): 888– 892.
95. Válek V, Kysela P, Kala Z et al. Brachytherapy and percutaneous stenting in the treatment of cholangiocarcinoma: a prospective randomised study. Eur J Radiol 2007; 62(2): 175– 179. Epub 2007 Mar 6.
96. Guo ZJ, Li Q et al. Diagnosis and treatment of hepatic cholangiocarcinoma: report of 52 cases. Hepatobiliary Pancreat Dis Int 2003; 2(1): 62– 65.
97. Ortner ME, Caca K, Berr F et al. Successful photodynamic therapy for nonresectable cholangiocarcinoma: a randomized prospective study. Gastroenterology 2003; 125(5): 1536– 1538.
98. Berr F, Wiedmann M, Tannapfel A et al. Photodynamic therapy for advanced bile duct cancer: evidence for improved palliation and extended survival. Hepatology 2000; 31(2): 291– 298.
99. Ustundag Y, Bayraktar Y. Cholangiocarcinoma: a compact review of the literature. World J Gastroenterol 2008; 14(42): 6458– 6466.
Labels
Paediatric clinical oncology Surgery Clinical oncologyArticle was published in
Clinical Oncology
![Issue 4](https://www.prolekare.cz/media/cache/resolve/journal_issue/media/image_pdf/f588f25582cf22690cb1d4943ea5a83b.jpeg)
2010 Issue 4
Most read in this issue
- Merkel Cell Skin Carcinoma
- Metastatic Breast Cancer in 28 Years Old Man
- Bile Duct Malignancies
- Targeted Therapy with an EGFR Tyrosine Kinase Inhibitor in Bronchioloalveolar Carcinoma of the Lung: A Literature Review and a Case Study of Clinically Prompt and Intensive Response to Erlotinib.