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Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2019; 7(14): 1732-1752
Published online Jul 26, 2019. doi: 10.12998/wjcc.v7.i14.1732
Diagnostic-therapeutic management of bile duct cancer
José María Huguet, Miriam Lobo, José Mir Labrador, Carlos Boix, Cecilia Albert, Luis Ferrer-Barceló, Ana B Durá, Patricia Suárez, Isabel Iranzo, Mireia Gil-Raga, Celia Baez de Burgos, Javier Sempere
José María Huguet, Carlos Boix, Cecilia Albert, Luis Ferrer-Barceló, Ana B Durá, Patricia Suárez, Isabel Iranzo, Digestive Disease Department, General University Hospital of Valencia, Valencia 46014, Spain
Miriam Lobo, Medical Oncology Department, General University Hospital of Valencia, Valencia 46014, Spain
José Mir Labrador, Celia Baez de Burgos, Unidad Hepática Avanzada, Servicio de Cirugía General y Digestiva, General University Hospital of Valencia, Valencia 46014, Spain
Mireia Gil-Raga, Medical Oncology Department, Hospital de Requena, Requena 46340, Spain
Author contributions: Huguet JM, Lobo M, Mir Labrador J, Boix C, Albert C, Ferrer-Barceló L, Durá AB, Suárez P, Iranzo I, Gil-Raga M, Baez de Burgos C, and Sempere J conceived the study and drafted the manuscript. All authors contributed to and approved the final version of the manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jose María Huguet, PhD, Assistant Professor, Doctor, Digestive Diseases Department, General University Hospital of Valencia, Avenida Tres Cruces, 2, Valencia 46014, Spain. josemahuguet@hotmail.com
Telephone: +34-606394982 Fax: +34-963131901
Received: March 19, 2019
Peer-review started: March 19, 2019
First decision: May 20, 2019
Revised: June 18, 2019
Accepted: June 26, 2019
Article in press: June 26, 2019
Published online: July 26, 2019
Processing time: 129 Days and 23.9 Hours
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.

Keywords: Bile duct cancer; Cholangiocarcinoma; Management; Diagnosis; Incidence; Multidisciplinary treatment

Core tip: This update provides a review of the diagnosis and management of biliary tract tumors. The document brings together the point of view of surgeons, oncologists, and gastroenterologists; therefore, it will be of use to clinicians who manage these challenging tumors. Treatment depends on staging. New diagnostic techniques such as cholangioscopy and new cancer treatments will play a key role in the not too distant future.