Bile duct cancer diagnosis

Note

All information given here is only of a general nature, tumor therapy always belongs in the hands of an experienced oncologist (tumor specialist)!

diagnosis

If a carcinoma of the biliary tract is suspected, the patient is first asked in detail (anamnese). A particular search is made for the symptoms that suggest biliary congestion. Then the patient physically examined. The first thing that often occurs is a yellowing of the skin (Jaundice) on. In some cases, when the tumor is occluding the gallbladder duct, the examiner can feel a painless, plump gallbladder in the right upper abdomen (Courvoisier's symbol).In advanced cases, the actual tumor may become palpable.

When analyzing the blood (laboratory), certain blood values ​​can indicate a disease of the biliary tract. For example, gamma-glutamyl transferase (Gamma-GT), alkaline phosphatase (AP) and the Bilirubin increased, which indicates a build-up of the bile but is not specific for the bile duct cancer. These blood parameters can also be increased in the case of other biliary tract obstructions, such as a gallstone, for example.

So-called Tumor markers are substances in the blood that are often found in some types of cancer and can thus indicate a cancer. They do not play an essential role in the initial diagnosis of gallbladder carcinoma, since it is not uncommon for false-positive results to be obtained. If, however, a certain tumor marker value is found to be elevated before the operation, which disappears after the operation, this marker can be used particularly well to prevent the tumor from breaking out again (Tumor recurrence) to recognize. Tumor markers that can be increased in bile duct cancer are: CA 19-9 and CEA.

A whole series of diagnostic methods must be carried out not only for the final diagnosis but also for the classification of the tumor stage.

• Sonography

With the Sonography (Ultrasound), abdominal organs are assessed non-invasively and without exposure to radiation. The expansion of the tumor, the extent of the Bile duct narrowing judged and suspicious or obvious affected lymph nodes uncovered in the abdomen. Since the method is easy to use and does not burden the patient, it can be repeated any number of times and especially used for progress control and follow-up care.

• Computed Tomography

The Computed Tomography (CT) creates layer images by means of X-rays and can provide information about the extent of the tumor, about the spatial relationship to neighboring organs (infiltration), about the lymph node involvement and also about distant metastases. Often, a CT scan of both the abdomen and the chest (thorax) needed to assess all metastatic routes (liver and lungs).
The Magnetic resonance imaging (MRI of the abdomen).

• Endoscopic retrograde cholangiopancreatography (ERCP)

In this examination method, an endoscope with side-view optics (duodenoscope) is advanced to the duodenum and the Major duodenal papilla (Papilla Vateri, Father's papilla) probed. This is the mouth of the common duct of the liver, gallbladder (ductus coledochus) and pancreas (ductus pancreaticus). If it is unsuccessful to push the instruments into the bile duct, it is necessary to carefully cut open the papillary opening in order to widen the opening. This measure is called Papillotomy or Sphincterotomy.

The second step of the investigation is Contrast media against the direction of flow of the digestive juices (retrograde) injected into these passages. During the injection of the contrast medium, an X-ray of the upper abdomen is taken. The contrast medium thus narrows the passages (Stenoses) going through Gallstones or Tumors emerged, visible and thus assessable. A bile duct carcinoma appears as long narrowing (Stenosis) of the biliary tract and extremely widened (dilated) Biliary tract in the liver before the tumor narrows. You can also use the endoscope to take a tissue sample from the tumor (biopsy) and have the pathologist examine the tissue (histologically) under the microscope, which can confirm the suspected diagnosis of bile duct cancer.

Therapy can be carried out in the same session during the ERCP.

For example, a gallstone can be removed with an inserted instrument or, in the case of narrowing caused by tumors or inflammation, by inserting one Plastic or metal tubes (Stent) the bile outflow can be restored.

• Percutaneous Transhepatic Cholangiography (PTC)

If the visualization of the biliary tract with ERCP is unsuccessful, there is the option of performing percutaneous transhepatic cholangiography. In this method, the liver is pierced (punctured) through the skin with a hollow needle and a bile duct is found. As with ERCP, a contrast agent is injected here too in order to visualize the bile ducts by means of an X-ray. It is also possible in this way to drain the bile to the outside via a so-called percutaneous transhepatic drainage (PTD) in order to remove a backlog in the bile ducts. In the case of inoperable tumors in particular, this can provide relief from severe jaundice.

• Chest x-ray

An overview X-ray of the chest (chest X-ray) is made to provide information about metastasis in the lungs.

Read more on the topic: Chest x-ray (chest x-ray)

• Endosonography (endoluminal ultrasound)

In an endoscopic ultrasound scan, as with a gastroscopy (esophago-gastro-duodenal endoscopy), a tube is first pushed into the duodenum (doudenum) in the immediate vicinity of the tumor. However, in this examination there is an ultrasound head at the end of the hose instead of a camera. With this method, the spread of the tumor in depth (infiltration) can be made visible by placing the transducer on the tumor and (regional) lymph nodes in the vicinity of the gallbladder can also be assessed.

A related method is intraductal biliary tract sonography, which can be used during both ERCP and PTC. For this purpose, a mini probe is inserted directly into the affected biliary tract and assessed with the ultrasound. If the bile duct wall is infected with tumors, it appears thickened on ultrasound and is characterized by the loss of the characteristic layering of the mucous membrane wall. In addition, the infiltration of neighboring structures by the tumor can be assessed with this method.

• Laparoscopy

In advanced tumor stages, it is sometimes necessary to perform a laparoscopy in order to correctly assess the regional extent, abdominal cavity involvement (peritoneal carcinosis) and liver metastases. During this procedure, which is carried out under general anesthesia, various instruments and a camera can be introduced through incisions in the skin of the abdomen and thus the spread of the tumor can be observed. In this way, if necessary, a tissue sample (biopsy) is taken so that the pathologist can assess the tumor in terms of tissue (histologically) under the microscope.