Cancer of the extrahepatic bile ducts is an infrequent tumor, the frequency of which is two times lower than the frequency of gallbladder cancer. Among the sick, men predominate in the 7th – 8th decade of life.
The reasons
Neoplasm is not often associated with ulcerative colitis, primary sclerosing cholangitis, choledochal cysts and other diseases. Communication with cholelithiasis is not typical.
Symptoms
Jaundice is a mandatory sign of damage to the bile ducts. In half of the observations, it begins suddenly. In the rest of the patients, pre-icteric symptoms are observed for about 2-3 months. Jaundice is usually intense and persistent. However, when the primary tumor is localized at the site of the triple junction of the ducts or in one of the lobar ducts, it may have an undulating or recurrent character. A more severe course of obstructive jaundice with the rapid development of symptoms of hepatic decompensation is observed with complete obstruction of the main ducts, causing the gallbladder reservoir to shut down. Given this, it is clinically necessary to distinguish between proximal and distal obstruction of the extrahepatic biliary tract with a border at the level of the triple junction of the ducts.
For large tumor stenoses, a significant increase in the liver is characteristic, and for distal stenoses, a positive symptom of Courvoisier is characteristic. However, an increase in the gallbladder with obstructive jaundice does not always indicate the level of obstruction, since it can be turned off as a result of blockade of the cystic duct by a tumor.
Cholangitis in duct cancer is observed in 38-55% of patients. Approximately with the same frequency pains are noted. Significant weight loss in duct cancer does not often have time to develop; this symptom is more characteristic of pancreatic cancer.
Diagnostics
Differential diagnosis of extrahepatic bile duct cancer has to be carried out with other cancer localizations in the organs of the pancreatoduodenal zone, as well as with obstructive jaundice caused by cholelithiasis. Establishing the correct diagnosis can be facilitated by ultrasound, computed tomography, magnetic resonance imaging, laparoscopy, and percutaneous cholangiography. In difficult cases, the diagnosis is specified on the operating table.
Treatment
For radical treatment of cancer of the distal common bile duct, pancreatoduodenal resection is recognized as the method of choice.
With a tumor lesion of the supraduodenal part of the hepatobiliary duct in a limited area, a more sparing operation, resection of the ducts with cholecystectomy, can be performed.
Tumor growth towards the gates of the liver sharply limits the likelihood of radical treatment.
The main type of care for patients with tumor obstruction of the extrahepatic biliary tract is palliative surgery aimed at eliminating jaundice. These operations are especially difficult for large stenoses, when there is a need to divert bile from the intrahepatic ducts.