Biliary tract cancer

This review outlines recent advances in the biology, diagnosis, and treatment of biliary tract cancer. Several studies unfold the carcinogenesis of biliary tract malignancies. The overexpression of p53 is noted in neoplasms of the extrahepatic bile ducts and gallbladder. Malignant cholangiocytes appear to be resistant to apoptosis as a result of increased Bcl-2 expression. Recent imaging studies validate the diagnostic role of ultrasonography as the primary modality in the evaluation of cholangiocarcinomas. Endoscopic or intraoperative ultrasonography may further improve the information provided by conventional imaging methods. Endoscopic brushing is the preferred technique for obtaining accurate pathologic results from bile duct strictures. Complete surgical resection remains the mainstay of treatment with hope for prolonged survival, and often entails resection of adjacent hepatic and vascular structures to achieve negative pathologic margins. Self-expandable metal stents are effective in providing biliary drainage for poor-risk surgical patients, and a study documents improved quality of life after stent placement. Gallbladder carcinomas invading the mucosa (pT1) are adequately treated by cholecystectomy alone. However, multiple series support radical surgical extirpation for more invasive tumors. Cancer is frequently found in large gallbladder polyps, and cholecystectomy is indicated based on size only (> 10 mm).