hepatobiliary system cancer

The hepatobiliary system, which includes the liver, gallbladder, and bile ducts, plays a crucial role in digestion and the production of bile. However, when these organs are affected by cancer, it can have severe consequences.

Types of Hepatobiliary Cancers

• The types of hepatobiliary cancers covered in medical guidelines include hepatocellular carcinoma (HCC), gallbladder cancer, intrahepatic cholangiocarcinoma, and bile duct cancer (cholangiocarcinoma) [1].
• Bile duct cancer, also known as cholangiocarcinoma, is a type of cancer that starts in the bile ducts [9].

Characteristics and Symptoms

• Hepatobiliary cancers can start in any part of the hepatobiliary system, including the liver, gallbladder, or bile ducts.
• Bile duct cancer typically starts in the cells lining the biliary tract, which includes the intrahepatic and extrahepatic bile ducts [8].
• Symptoms may include jaundice, itching, weight loss, and abdominal pain.

Causes and Risk Factors

• The exact causes of hepatobiliary cancers are not well understood, but risk factors include liver disease, gallstones, and certain genetic conditions.
• Intrahepatic cholangiocarcinoma is often associated with chronic inflammation and fibrosis in the bile ducts.

Treatment Options

• Treatment options for hepatobiliary cancers depend on the type and stage of cancer, as well as the patient's overall health.
• Surgical resection may be an option for early-stage cancers, while chemotherapy and radiation therapy are often used to treat more advanced cases.

References:

[1] AB Benson III · 2009 · Cited by 71 [8] by Z Zamani · 2023 · Cited by 8 [9] Oct 11, 2024

The hepatobiliary system, which includes the liver, gallbladder, and bile ducts, plays a crucial role in digestion and metabolism. Cancer in this system can be challenging to diagnose, but there are some common signs and symptoms that may indicate its presence.

Common Signs and Symptoms:

• Jaundice: Yellowing of the skin and whites of the eyes due to bilirubin buildup [1][5]
• Unintentional weight loss: Weight loss without trying, which can be a sign of cancer-related malnutrition [3][4][6]
• Loss of appetite: Decreased interest in food, leading to inadequate nutrition [2][3][6]
• Abdominal pain: Pain in the upper right abdomen or shoulder blade area, which can radiate to other areas [3][7]
• Nausea and vomiting: Feeling queasy or vomiting due to cancer-related obstruction of bile ducts [2][5]
• Dark-colored urine: Urine that is darker than usual due to bilirubin buildup [1][5]
• Clay-colored stool: Stool that is pale or clay-colored, indicating a lack of bile in the digestive system [5]

Other Possible Symptoms:

• Fatigue and weakness
• Pale or itchy skin
• Abdominal swelling or bloating

It's essential to note that these symptoms can also be caused by other conditions, such as gallstones, pancreatitis, or liver disease. If you're experiencing any of these symptoms, consult a healthcare professional for proper evaluation and diagnosis.

References:

[1] Context result 1: Yellowing of your skin and the whites of your eyes (jaundice); Intensely itchy skin; White-colored stools; Fatigue; Abdominal pain on the right ...

[2] Context result 2: Loss of appetite · Feeling very full after a small meal · Nausea or vomiting · An ...

[3] Context result 3: When signs and symptoms do appear, they may include unintentional weight loss, loss of appetite, upper abdominal pain, nausea and vomiting, ...

[4] Context result 4: jaundice – yellowing of the skin and the whites of the eyes, itchy skin, pale stools and dark-coloured urine. unintentional weight loss.

[5] Context result 5: Signs and symptoms of bile duct cancer · jaundice (yellowing of the skin or whites of the eyes) · dark urine · clay colored stool · pain in the ...

[6] Context result 6: Liver cancer symptoms vary person to person. 1. Unintended weight loss 2. Pain in right upper abdomen or shoulder blade 3. Loss of appetite 4.

[7] Context result 7: Patients with common hepatic and common bile duct cancers present earlier with painless, obstructive jaundice. These lesions are smaller and have a somewhat ...

Diagnostic Tests for Hepatobiliary System Cancer

The diagnosis of hepatobiliary system cancer, including liver and bile duct cancers, involves a combination of imaging tests, laboratory tests, and physical examination.

• Imaging Tests: These are essential for accurately diagnosing biliary tract disorders and detecting focal liver lesions (e.g., abscess, tumor) [1]. The following imaging tests are used to stage liver cancer:
  • CT scans
  • MRIs
  • Bone scans There are different methods of staging liver cancer, such as the TNM system, which takes into account the size and location of the tumor, as well as whether it has spread to lymph nodes or distant organs [2].
• MRI: This imaging test is used to examine the liver, pancreas, and many other organs. It can assess blood flow and detect many forms of cancer, including hepatobiliary system cancers [3].
• Medical Exam: A physical exam and complete medical history are essential for diagnosing hepatobiliary cancer. The doctor will perform a thorough examination, taking into account the patient's symptoms, medical history, and family history [4].
• Laboratory Tests: These tests can help screen for liver disorders and detect abnormalities in liver function. The most useful laboratory tests include:
  • Serum aminotransferases (the most commonly used liver tests)
  • Bilirubin
  • Alkaline phosphatase These tests can indicate liver damage or disease, but they are not specific to hepatobiliary cancer [5].
• HIDA Scan: This imaging test is an important tool for diagnosing certain issues in the liver, bile ducts, and gallbladder. It involves injecting a radioactive substance that highlights the bile ducts and gallbladder on an image [6].

References

[1] Imaging is essential for accurately diagnosing biliary tract disorders and is important for detecting focal liver lesions (eg, abscess, tumor).

[2] Apr 28, 2023 — Imaging tests used to stage liver cancer include CTs , MRIs and bone scans. There are different methods of staging liver cancer.

[3] An MRI is used to examine the liver, pancreas and many other organs. It can assess blood flow and detect many forms of cancer.

[4] Medical exam: The first step in diagnosis is to do a physical exam and take your complete medical history.

[5] The most useful laboratory tests to screen for liver disorders are serum aminotransferases (the most commonly used liver tests), bilirubin, and alkaline phosphatase.

[6] A HIDA scan (hepatobiliary iminodiacetic acid scan) is an important test for diagnosing certain issues in your liver, bile ducts and gallbladder.

Treatment Options for Hepatobiliary System Cancer

Hepatobiliary system cancer, also known as bile duct cancer, can be treated with various drug therapies. Here are some of the most common treatment options:

• Targeted Therapy: Targeted drugs attack specific parts of cancer cells that help them grow. These drugs can be used to treat advanced bile duct cancer and have shown promise in improving survival rates [1].
• Gemcitabine: Gemcitabine is a chemotherapy drug that has been used as an anchor treatment for advanced biliary tract cancers. It has been shown to be effective in treating patients with good general health, but may not be suitable for those in poorer health [4].
• Cisplatin and Gemcitabine: A combination of cisplatin and gemcitabine is often used as a first-line treatment for patients with good general health. This regimen has been shown to be effective in treating advanced bile duct cancer [9].
• Durvalumab and Chemotherapy: Durvalumab, an immunotherapy drug, has been shown to modestly improve survival rates when combined with chemotherapy (gemcitabine and cisplatin) for patients with biliary tract cancer [5].

Other Treatment Options

In addition to these drug therapies, other treatment options are available for hepatobiliary system cancer. These include:

• Surgical Resection: Surgical resection remains the mainstay of cure for bile duct cancer. Adjuvant therapy with capecitabine is recommended after surgery [7].
• Photodynamic Therapy: Photodynamic therapy involves injecting a light-sensitive chemical into a vein, which accumulates in fast-growing cancer cells. Laser light is then used to destroy these cells [6].

References

[1] Targeted drugs attack specific parts of bile duct cancer cells that help them grow. Learn more about bile duct cancer targeted therapy here. [2] Gemcitabine as an anchor drug for the treatment of advanced biliary tract cancers is further supported by a retrospective review of 304 patients with ... [3] Triplet therapy combining gemcitabine, cisplatin, and the anti-programed death-ligand 1 (PD-L1) checkpoint inhibitor durvalumab has demonstrated the first major ... [4] Gemcitabine 1000 mg/m^2 IV once a week for 3 of every 4 weeks for 6 months. · Leucovorin 20 mg/m^2 IV bolus then 5-FU 425 mg/m^2 IV bolus on days ... [5] Results from the TOPAZ-1 trial found the immunotherapy drug durvalumab modestly improved survival in people with biliary tract cancer. [6] Photodynamic therapy. In photodynamic therapy, a light-sensitive chemical is injected into a vein and accumulates in the fast-growing cancer cells. Laser light ... [7] Surgical resection remains the mainstay of cure for BTC. · Adjuvant therapy for 6 months with capecitabine is recommended after surgery. [8] by A Lamarca · 2022 · Cited by 84 — Surgical resection remains the mainstay of cure for BTC. · Adjuvant therapy for 6 months with capecitabine is recommended after surgery. [9] Patients in good general health typically receive a combination of cisplatin and gemcitabine. Patients in poorer health might be offered treatment with a single ...

The differential diagnosis of hepatobiliary system cancers involves considering various conditions that can mimic or coexist with primary liver, gallbladder, and bile duct cancers.

Common Differential Diagnoses

• Hepatocellular Carcinoma (HCC): The most common type of liver cancer, which can be difficult to distinguish from other liver lesions.
• Metastatic Liver Cancer: Cancer that has spread to the liver from another part of the body, such as the breast, lung, or colon.
• Gallbladder Adenomas: Benign tumors of the gallbladder that can be mistaken for cancerous growths.
• IgG4-Related Sclerosing Cholangitis: A rare condition characterized by inflammation and scarring of the bile ducts, which can mimic cholangiocarcinoma.
• Gallbladder Polyps: Benign growths on the gallbladder that can be difficult to distinguish from cancerous lesions.

Other Differential Diagnoses

• Bile Duct Strictures: Narrowing or blockage of the bile ducts, which can cause symptoms similar to cholangiocarcinoma.
• Biliary Cirrhosis: Scarring of the liver and bile ducts, which can lead to complications such as jaundice and ascites.
• Dysplastic Nodules in Cirrhosis: Abnormal growths on the surface of the liver that can be difficult to distinguish from HCC.

Importance of Accurate Diagnosis

Accurate diagnosis is crucial for determining the best course of treatment and improving patient outcomes. A thorough evaluation, including imaging studies, biopsy, and clinical assessment, is necessary to rule out other differential diagnoses and confirm the presence of hepatobiliary system cancer.

References:

• [1] by Z Zamani · 2023 · Cited by 8 — Differential Diagnosis
• [2] by RM Gore · 2007 · Cited by 59 — Ultrasound, CT, and MR are the primary means of non-invasively diagnosing and staging cholangiocarcinoma and these studies need to depict the overall extent of ...
• [3] by C Lopes Vendrami · 2021 · Cited by 42 — Gallbladder carcinoma is the most common cancer of the biliary system. It is challenging to diagnose because patients are often asymptomatic ...
• [4] May 2, 2018 — Differential Diagnoses
• [5] Oct 14, 2024 — Diagnostic Considerations