Biliary tract cancer

A better understanding of the biology of biliary tract cancers and several new techniques improving their management are highlighted in this review. The molecular events leading to biliary tract carcinomas continue to unfold. The biliary tract shares the same foregut origin as the pancreas and K-ras mutations occur in biliary tract cancers as frequently as in pancreatic adenocarcinomas. Flow cytometry analysis of hilar cholangiocarcinoma shows worse survival in aneuploid tumors and aneuploidy may be associated with a better response to radiation therapy. Preoperative imaging and diagnostic techniques for biliary tract cancers have been refined. Intraductal biliary ultrasonography is a new modality capable of assessing the relationship between biliary tract cancers and the vessels in the hepatoduodenal ligament. Surgery remains the mainstay of treatment of biliary tract carcinomas. Several recent studies confirm an improved prognosis as a result of combined local and hepatic resection including the caudate lobe in hilar cholangiocarcinomas. In unresectable biliary tract cancers, expandable endoprostheses are increasingly used because they have a lower occlusion rate than conventional stents. Results of conventional surgical treatment for gallbladder carcinoma remain poor as attested by a large multicenter study. An aggressive approach combining hepatic resection and radical lymphadenectomy for gallbladder carcinoma seems justified because specialized centers report impressive long-term survival (>50% at 5 years). Recent technical advances in adjuvant radiation therapy have improved the capacity of delivering higher radiation dosages externally (conformal irradiation portals) and through localized implant catheters in biliary tract cancers.