According to statistics from the world medical community, cholangiocarcinoma accounts for about 2% of all types of cancer, as well as up to 10% of the total number of cases of liver and biliary tract cancer. Moreover, the diagnosis of this type of tumor is very low: only 1.5-2%. The Klatskin Tumor is named after the pathomorphologist Gerald Klatskin, a doctor from America. In 1965, while working at Yale University, he, based on 13 cases of the disease, described all the features of this ailment.
Cholangiocarcinoma, or cancer of the liver and bile ducts
Klatskin's tumor is a rather dangerous disease. This neoplasm is characterized by slow growth and late development of metastases. Due to untimely diagnosis and the inability to perform surgical removal, the disease has a high mortality rate. The diagnosis in most cases is made at the last stages of the development of formations, which excludes surgical intervention. The development of metastases directly affects the liver, liver gate, regional lymph nodes, as well as the abdominal cavity. Tumor growth occurs from liver epithelial cells. The disease is formed mainly after 50 years, but every year the age of patients decreases. Men are slightly more likely to become sick than women.
Probable causes of the tumor
The causes of the formation of liver cholangiocarcinoma are not exactly known. But scientists have found factors whose influence increases the risk of neoplasm. If there is a history of primary sclerotizing cholangitis in patients in 40 cases out of 100, Klatskin's disease can form.
A tumor is formed with a frequency of 25 cases out of 100 on the basis of hereditary diseases, such as
Caroli's disease. An inflammatory reaction due to intrahepatic parasites can trigger a neoplasm.
Bad habits that affect liver health: smoking, alcohol addiction, malnutrition, leading to obesity are indisputable factors for the progression of the disease. The presence of cholelithiasis increases the likelihood of a tumor. At risk are people exposed to prolonged contact with toxins and harmful substances. Viral infections, mainly hepatitis, contribute to the development of cancers.
Symptoms of cholangiocarcinoma
Since malignant tumors in the liver are difficult to diagnose, you need to listen to your body for early detection of Klatskin disease.
A tumor may be characterized by symptoms such as:
- the main symptom of the disease is obstructive jaundice;
- constant sensation of itching;
- drawing pain in the upper right abdomen;
- loss of appetite and, as a result, a sharp decrease in weight;
- physical exhaustion characteristic of tumor formations;
- an increased temperature with a Klatskin tumor also occurs;
- changes in the color of urine and stool (urine darkens and stools lighten).
Symptoms appear unexpectedly and progress. Obstructive jaundice occurs in 90 cases out of 100 and is one of the common signs of a disease such as Klatskin's tumor. Reviews of patients sometimes vary. Some patients report the onset of itching, pain, and a sharp loss in weight. Such manifestations are caused by late stages of malignant tumors. But others do not feel almost any deviations in the state of health or associate the symptoms with other ailments.
Diagnosis of Klackin's tumor
To establish the diagnosis, a series of clinical studies are carried out that can accurately indicate the presence of Klatskin's disease. The tumor is clearly visible when screened on an ultrasound machine. This is a fairly economical, harmless and easily accessible method. Using spiral computed tomography, it is easy to detect abnormalities in the work of the gallbladder, to see damage to the liver and lymph nodes. Using MRI (magnetic resonance imaging), with the introduction of contrast fluid into the liver, it is possible to determine with high accuracy the state of the liver tissue and the degree of narrowing of the bile ducts with a diagnosis of Klatskin tumor. The photo shows all parts of the liver and bile ducts.
X-ray and X-ray examination shows problems with the biliary tract. In the process of diagnosis, a contrast agent is introduced, allowing you to see the outflow of bile. Biochemical blood tests will help identify the level of enzymes and bilirubin. Cancer tests can also be assigned to identify cancer bodies: CA 199, CA 125.
Quite often, tumor processes reach the hepatic artery and portal vein, supplying blood to the liver. Before surgery, it is very important to determine the stage of the neoplasm in order to clarify whether the disease has spread to the blood vessels. In some cases, such a diagnosis is difficult and then the question of the extent of the resection is resolved during the surgical operation.
Methods for the treatment of neoplasms
If untreated, patients in most cases have an average life expectancy of 6 months after determining the exact diagnosis. At an early stage, Klatskin's disease is rarely detected. The tumor is treatable in the last stages quite ineffectively.
Surgery is one of the main methods of treating a tumor. But due to late diagnosis, the operation has a low survival threshold (on average 20%). To achieve a positive effect, the complete removal of the damaged part of the bile ducts is used, together with the removal of one lobe of the liver, in order to avoid infection of the blood vessels.
Surgery is possible in several cases:
- the formation did not affect the circulatory system of the liver; in this case, it is possible to remove the site or the entire share of the damaged liver;
- the formation did not affect the bile duct of one or both lobes of the liver.
An inoperable disease is considered when a tumor penetrates into the blood vessels of the liver or into the choleretic ducts of both its lobes.
Palliative treatments
In inoperable cases or as adjunctive therapy, palliative care is used .
These methods include:
- drainage of the biliary tract;
- chemotherapy;
- radiation therapy;
- shunting;
- photodynamic therapy;
- irradiation with highly focused ultrasound rays.
When combining several treatment methods in conjunction with early diagnosis, life expectancy can be increased from 10 months to 5 years.
Prognosis after treatment
Due to the fact that the processes of tumor formation in the liver are quite slow, the life expectancy is from one and a half to five years. The complete removal of damaged areas allows you to increase the life span with accurate and timely diagnosis of Klatskin's disease.
A tumor found inside the liver has disappointing predictions. This is one of the worst indicators observed in patients with inoperable formations with metastases. Such patients can only rely on drainage of the biliary tract. If a Klackin’s tumor is diagnosed inside the liver, the patient’s life expectancy sometimes does not exceed several weeks.
The cause of death, oddly enough, is not metastases, but concomitant complications. These include:
- cirrhosis of the liver caused by abnormal outflow of bile;
- infections leading to the formation of abscesses;
- general atrophy of the body and failure of the immune system;
- purulent-inflammatory processes.
Preventative measures
For the prevention of tumor diseases of the liver and bile ducts, it is necessary to adhere to proper nutrition, not to abuse alcohol and to prevent infection with parasites.
If there is a history of diseases that are positioned as risk factors, then timely treatment and a systematic examination should be carried out for early detection of abnormalities in the functioning of bile ducts. It is also necessary to exclude exposure to harmful substances, such as in the workplace.
Finally
Modern diagnostic equipment allows you to detect tumor processes in the liver and bile ducts, as well as determine the degree of complexity of surgical intervention. The use of new methods for the operative resolution of the problem, transplantation and additional therapeutic measures leads to an increase in the quality and longevity of patients.