Question: A 47 year old female with biopsy-proven cholangiocarcinoma, measuring 3.3 cm, is sent to you for treatment. What do you recommend?

A. transplant evaluation

B. refer to surgeon and oncologist

C. there is no treatment

D. send to IR for radiofrequency ablation

Answer: Cholangiocarcinoma (CCA) is a grave diagnosis to make; it is very difficult to cure in part due to its micrometastases and poorly defined margins.  A limited size lesion, however, should be considered for surgical resection.  Adjuvant therapy, with radiation or chemotherapy, should be considered as well, but there is little proven benefit.

Perhaps you considered referral for transplantation evaluation? Reasonable thought, however, there are very few centers in the US that transplant cholangiocarcinomas.  For those that do, having a biopsy proven CCA is a contraindication due to the risk of seeding cancerous cells along the biopsy needle track.  The transplant protocol is extensive and calls for chemotherapy, brachytherapy, an exploratory laparotomy and more chemotherapy…and that’s all before the transplant.  Like I said, tough diagnosis.

Radiofrequency ablation is a locoregional procedure most often used for hepatocellular carcinoma, not CCA.  It is most beneficial in HCC less than 3 cm, when the lesion is not next to a vital organ (like gallbladder) or a major blood vessel.

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