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Reply periampullary cancer associated 70-year-old, in April 2010 diagnosed bile duct cancer, doctors told not much hope of these patients, the average life expectancy of 6 months. Late bile duct cancer, has no need for surgery and chemotherapy. Want to know: There is no suitable in Western medicine, in order to delay life, and reduce recurrence after treatment . cholangiocarcinoma bolt? Cholangiocarcinoma cholangiocarcinoma cholangiocarcinoma consider how to treat late, or need laparotomy, bile duct cancer early surgery, the survival time How long on average. Two old high fever, check the doctor said there may be bile duct, but no diagnosis of cholangiocarcinoma may you ask are tied after bile duct hepatocellular carcinoma. Cholangiocarcinoma recurrence bolt from Jinzhou hospital is not Han bile duct cholangiocarcinoma cancer (Linyi City Hospital conclusions) in the Central Hospital diagnosed as Wanzhou (cholangiocarcinoma late) the best Chinese medicine hospital treatment of cholangiocarcinoma cholangiocarcinoma cholangiocarcinoma has spread to related articles pancreas and liver, the body jaundice, how is it treated? Traditional Chinese medicine effective? Bile duct cancer without surgery, radiotherapy and chemotherapy in addition, are there any ways to control and treatment? Jaundice and the clinical symptoms of pancreatic bile duct cholangiocarcinoma, gallbladder and bile duct of the gamma knife treatment of cholangiocarcinoma of the inspection items
The cause of cholangiocarcinoma is not very clear so far, have been found with the following factors:
1. Biliary chronic inflammation, infection, chronic inflammatory stimulation of the long-term factors are the basis of occurrence of cholangiocarcinoma, bile duct cancer because of clinical findings and associated diseases can lead to chronic bile duct inflammation. Certain substances in bile (eg bile acid metabolites) long-term stimulation of the biliary mucosa, leading to dysplasia.
2. Bile duct, gall bladder stones 20% to 57% of cholangiocarcinoma patients associated with gallstones, so that the stones of the chronic stimulation may be carcinogenic factors.
3. Ulcerative colitis has been reported, the incidence of ulcerative colitis patients with bile duct cancer 10 times higher than the general population. Ulcerative colitis patients with cholangiocarcinoma who earlier age than the average 20 to 30 years, with an average of 40 to 45 years, often long-term history of colitis, patients with chronic portal vein bacteremia may induce cholangiocarcinoma and PSC reasons, many diseases affecting the entire colon, ulcerative colitis may be caused by bile duct cancer related to chronic portal vein bacteremia.
4. Biliary cystic malformation (congenital bil
5. Clonorchiasis (Chinese branch of C. sinensis) infected with Clonorchis sinensis infection was considered to be linked to the occurrence of cholangiocarcinoma, although the multi-parasitic clonorchiasis in the intrahepatic bile ducts, but can also be parasitic in extrahepatic bile duct, insects body itself and its metabolites on the long-term stimulation of bile duct epithelium, causing mucosal bile duct proliferation, resulting in tumor-like changes in cancer.
6. Biliary tract surgery in bile duct cancer can occur many years after surgery, can occur without stones in the bile duct, the main cause of chronic biliary tract infection between epithelial changes, often in the biliary drainage postoperatively.
7. Radioactive thorium dioxide and thorium in patients with history of exposure, age of onset of cholangiocarcinoma than those without a history of thorium exposure 10 years earlier, the average incubation period of 35 years (after exposure to thorium), and a higher incidence of bile duct peripheral tree.
8. Sclerosing cholangitis, malignant primary sclerosing cholangitis (PSC) patients suffering from bile duct cancer is also higher than the general population the opportunity, PSC is also concerned with ulcerative colitis.
9. Hepatitis B virus infection in patients with bile duct cancer associated with the domestic part of the hepatitis B virus infection, whether there is contact between the two remains to be elucidated.
10.K-ras gene mutations in molecular biology in recent years, studies have shown that K-ras gene in cholangiocarcinoma codon 12 mutation rate was 77.4%, indicating that K-ras gene mutations occur in the bile duct may play a more important role.
In addition, may be related to pancreatic juice reflux, bile stasis, stone formation, benign bile duct malignancy, liver stem cells, tumor-like differentiation. Can result in chronic inflammation of bile duct mucosa, and then induced cholangiocarcinoma.
(B) of the pathogenesis
Cholangiocarcinoma can occur in all parts of extrahepatic bile duct, bile duct segments in which nearly (hilar bile duct) the most common, accounting for about 58%; distal bile duct were 13% and 18% (Figure 1), occurred in the cystic duct were 4%, and 7% for diffuse occur.
1. Pathologic features
(1) gross morphological classification: According to the general form of cancer can be divided into papillary type cholangiocarcinoma, sclerosing, nodular and diffuse infiltrative 4 types. Among them, see infiltrating more, followed by nodular, and papillary rare. The formation of bile duct cancer are usually less mass, and more about the wall infiltration, thickening, lumen occlusion; cancer is easy to surrounding tissue infiltration, nerve and liver often violated; patients often complicated by the liver and biliary tract infection and death.
â‘ papillary carcinoma: Gross morphology was papillary friable white or pink tissue, and often multiple lesions tube to the surface growth, the formation of papillary structures of varying sizes, arranged in neat rows between cancer cells may have normal tissue. Occur in the lower bile duct, bile duct is not easy to cause complete obstruction. This type of tumor infiltration of the main upward along the bile duct mucosa, generally not to the bile duct tissue, blood vessels, nerve and liver lymphatic space invasion. Surgical success rate, favorable prognosis.
â‘¡ curing cancer: performance of ring gray induration, often infiltrate along the bile duct submucosa, thickening of the bile duct wall, a large number of fibrous tissue proliferation, invasion and tube formation to the fibrous lumps; with part of the bile duct occlusion, with bile duct lesions ulcers, chronic inflammation, and dysplasia exist. Occur in the liver bile duct, hilar cholangiocarcinoma is the most common type. Sclerosing well-differentiated cancer cells, often scattered in a large number of connective tissue fibers, easy and sclerosing cholangitis, bile duct scarring caused by chronic inflammation, fibrosis confused, sometimes even in the frozen tissue biopsy surgery Check also difficult to make a correct diagnosis. Curing cancer, a clear upward infiltration along the bile duct to the bile duct and liver parenchyma surrounding tissue, the tendency of violations, it is often required radical resection of hepatic resection. However, surgical margin often residual tumor tissue, reaching less than the true radical resection, the prognosis is poor.
â‘¢ nodular cancer: the formation of a sudden to the bile duct tumor distant nodules at the base and continuous with bile duct wall, the duct surface often irregular. Tumor is generally small, the base width, surface irregularities. This type of tumor usually infiltrates along the bile duct mucosa to the bile duct infiltration of surrounding tissue and blood vessels than the curing light, high rate of surgical resection, the prognosis is good.
â‘£ diffuse infiltrative cancer: rare, accounting for 7% of cholangiocarcinoma. Cancer extensive infiltration along the intrahepatic bile duct, bile duct, wall thickening, stenosis, significant perivascular connective tissue inflammation, is difficult to determine the occurrence of bile duct cancer, the original site, usually unresectable and poor prognosis.
(2) histologic classification: 95% of the bile duct adenocarcinoma, a small number of squamous cell carcinoma, mucinous carcinoma, cystadenocarcinoma, etc., in primary extrahepatic cholangiocarcinoma, the most common bile duct cancer, 33% ~ 40%; followed by the hepatic duct carcinoma, 30% ~ 32%; hepatic duct bifurcation, 20%; cystic duct 4%.
Extrahepatic cholangiocarcinoma lack of uniform histologic classification, commonly used by cancer type differentiation and growth patterns were divided into 6 types: â‘ papillary adenocarcinoma; â‘¡ adenocarcinoma; â‘¢ poorly differentiated adenocarcinoma; â‘£ undifferentiated carcinoma ; â‘¤ signet ring cell carcinoma; â‘¥ squamous cell carcinoma, adenocarcinoma common. Each type of report are not consistent, but the most common histological type is still papillary adenocarcinoma, well differentiated adenocarcinoma, accounting for 90% or more, a small number of poorly differentiated adenocarcinoma and mucinous adenocarcinoma, common bile duct is also rare Leiomyosarcoma of the reports.
2. Transfer means about 71.4% of the bile duct has a direct invasion or metastasis, which spread to the liver 33.3%, 33.3% owned affected lymph nodes, 17.5% for the peritoneal dissemination. Blood vessels around the bile duct, lymphatic network and nerve plexus surrounded, cholangiocarcinoma cells around the bile duct through a multi-channel along the intrahepatic or extrahepatic spread, retention, growth and reproduction. Cholangiocarcinoma, including the transfer of lymph node metastasis, hematogenous metastasis, nerve transfer, invasion and metastasis, etc., the above can be transferred to a variety of ways in many other organs. Hilar cholangiocarcinoma cells via multi-channel along the bile duct lymph, blood vessels and nerves around the gap, the direction and ligament liver spread and spread, but less distant metastasis.
(1) lymph node metastasis: more common. Often transferred to the hepatic portal and pancreatic lymph nodes, and less distant lymph node metastasis, lymph node metastasis above the higher rate of bile duct segments. Bile duct in the liver and portal vein, hepatic artery branches surrounding the Glisson sheath, in which there is a wealth of nerve fibers and lymph. Glisson sheath extend outside the hepatoduodenal ligament, and its memory in a more abundant nerve fibers, lymphatic vessels, lymph nodes, and loose connective tissue, and bile duct itself has a rich submucosal lymphatic vessels and pipe network. In recent years with the development of high bile duct resection, lymph node drainage of hilar attention. Some of the 27 patients with hilar lymph node dissection, the proof of the liver behind the portal vein after transverse groove there lymph nodes, lymphatic drainage of the thick along the portal vein, and lymph nodes in the gallbladder, common bile duct and the hepatic artery lymph node lymphatic vessels between the thick connected.
Lymph node metastasis is the most common way of cholangiocarcinoma, and may occur very early. It has been reported only limited pathology of early bile duct mucosa, there were regional lymph node metastasis. Bile duct lymph node groups are: â‘ the cystic duct lymph node; â‘¡ lymph nodes around the common bile duct; â‘¢ omental lymph nodes holes; â‘£ pancreaticoduodenectomy before and after the lymph nodes; â‘¤ after pancreaticoduodenal lymph nodes; â‘¥ portal lymph nodes ; â‘¦ celiac lymph node; â‘§ hepatic artery lymph nodes; â‘¨ adjacent hepatic artery before and after lymph node; â‘© superior mesenteric artery lymph node, is divided into the superior mesenteric artery, inferior pancreaticoduodenal artery and the roots of colonic artery the roots of the first jejunal artery and 4 lymph nodes. Overall, hilar lymph node metastasis is the main pathway along the hepatic artery; the middle of extensive lymph node metastasis of cholangiocarcinoma, in addition to violations of pancreatic lymph nodes, but also involving the superior mesenteric artery and aortic lymph nodes; in the distal bile duct, more limited lymph node metastasis around the head of the pancreas.
(2) invasion and metastasis: more common. Cholangiocarcinoma cells along the bile duct wall and down and around to the direct infiltration is one of the main features of bile duct cancer metastasis. The upper part of the liver bile duct to the adjacent bile duct infiltration, bile duct to the middle hepatic artery and portal vein invasion, infiltration of the lower bile duct to the pancreas. More in the bile duct cancer cells within the diffuse infiltrative growth, and with the bile duct and the surrounding connective tissue proliferation coexist, making it difficult to identify the scope of bile duct invasion, in order to determine the surgical resection difficult. In addition, the result of direct infiltration around the bile duct has also led to important adjacent structures such as large blood vessels, liver involvement, resection of surgery is limited and difficult to achieve radical resection, and residual cancer is the main cause of relapse soon after one. The upper part of the main bile duct cancer liver metastases is the transfer method, peritoneal dissemination is rare.
(3) hematogenous metastasis: up the body, most commonly the lung, 10% to 25%. Pathological studies have shown that cholangiocarcinoma specimens and peripheral vascular involvement were found up to 58.3% ~ 77.5%, indicating that blood is a violation of the common bile duct carcinoma cell biological phenomena. Density of tumor blood vessels and bile duct cancer were significantly related to the transfer, and with the increase of tumor blood vessel density also increased the incidence of metastasis, suggesting that tumor angiogenesis and metastasis in cholangiocarcinoma play an important role. Clinical observation to the lymphatic system cholangiocarcinoma often happens, in fact, tumor angiogenesis and vascular invasion and lymphatic metastasis. Therefore, in the bile duct during the invasion and metastasis, tumor angiogenesis and vascular invasion is the basic link.
(4) spread along the nerve: the incidence of neural invasion of up to 33.3% ~ 83.4%, so the clinical symptoms of jaundice and pain is more common. Dominant extrahepatic bile duct of the vagus nerve and sympathetic in the hepatoduodenal ligament on the composition of the liver and liver before the nerve plexus nerve plexus. Outer membrane surrounding the nerve fibers have a complete and continuous space, known as the perineural space (perineural space). More than ever that the perineural space is an integral part of the lymphatic system, but later proved by light and electron microscopy, perineural space is a separate system, without any relationship with the lymphatic system, tumor cells may be directed to the proximal perineural space or remote shift in the direction. Statistics show that perineural space invasion and liver cancer and liver metastasis was significantly associated ligament connective tissue, suggesting that in some cases the liver, hepatoduodenal ligament and the connective tissue around the metastasis may be through the gap cancer perineural cell proliferation achieved. Therefore, perineural space invasion should be an important factor to determine prognosis of.
3. Cholangiocarcinoma clinical staging more than the current clinical use of the International Union Against Cancer (UICC) TNM staging of the standard conditions of measurement to determine treatment strategies and assess the prognosis is an important reference (Table 2).
Bismuth-Corlette place under the lesion site, will be divided into the following hilar type 5 (Figure 2), is now widely used in clinical and abroad:
â… : the tumor in the hepatic duct, confluence does not infringe the Ministry;
â…¡: the tumor in the left hepatic duct confluence of the Department, does not infringe the left and right hepatic duct;
â…¢: convergence of bile duct cancer and has been in violation of the right hepatic duct (â…¢ a) or a violation of the left hepatic duct (â…¢ b);
â…£: the tumor has violated the bilateral left and right hepatic ducts.
On this basis, the domestic scholars in turn divided into type â…£ â…£ a and â…£ b type.
Reference: the cause of cholangiocarcinoma
Reference: The symptoms of cholangiocarcinoma
Reference: Check cholangiocarcinoma
Reference: Identification of bile duct cancer
Reference: bile duct complications
Reference: Prevention of bile duct cancer
Reference: the treatment of cholangiocarcinoma
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ask655099199 send a message add as a friend I want to reward 0 Favorites answer complaint (7) :2009 question-5-29 13:32:22
Life of patients with cholangiocarcinoma
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Beijing Branch of Cancer Research
010-84121599 question their doctors more recovery time :2009-5-29 14:30:52 complaint
Hello, the length of survival depends on age, physical condition of patients with post-treatment levels and the situation there is also a factor in patients with mental illness have great impact on
The response from: North cancer, the Institute of Medicine Health Science ã€You have a new perspective on the answers, please 0 Commentsã€‘ timely support for the answer to the reply No comment! Member advice clinic reference area
Ren Qiaoyun Director
Traditional Chinese Medicine Cancer Hospital, Shijiazhuang Huaguang
0311-85376166 question back to their doctors more time :2009-5-29 13:37:06 complaint
ask655099199 Hello, It depends on what the specific conditions of patients, and how to treat!
The response from: Traditional Chinese Medicine Cancer Hospital, Shijiazhuang Huaguang ã€You have a new perspective on the answers, please 0 Commentsã€‘ timely support for the answer to the reply No comment!
Zhou Fengwei Director
Peace Hospital in Shijiazhuang
0311-86012461 question their doctors more recovery time :2009-5-29 14:06:48 complaint
Hello, bile duct malignancy is high, depending on the circumstances, survival is different, generally only 3 short months, if well controlled by treatment, even in advanced, but also want to extend 2-3 years. If it is early days, through the consolidation of surgical and postoperative treatment, cure, there is hope. so at your specific condition of the patient told me that I can for you analysis.
The response from: Peace Hospital in Shijiazhuang ã€you would have new ideas, please reply promptly Commentsã€‘ 2 people to support the answer to the reply No comment!
Traditional Chinese Medicine Cancer Hospital, Shijiazhuang Fu Shan
0311-83980152 question their doctors more recovery time :2009-5-29 14:13:35 complaint
Early bile duct cancer surgery can be cured, although the cure of advanced integrated treatment difficult but can give long-term chances of survival are many.
CEA homology theory under the concept of using "targeted anti-cancer medicine cocktail therapy" is also commonly used treatment.
The response from: Traditional Chinese Medicine Cancer Hospital, Shijiazhuang Fu Shan ã€you would have new ideas, please reply promptly Commentsã€‘ 1 to support the answer to the reply No comment!
Traditional Chinese Medicine Cancer Hospital, Shijiazhuang Fu Shan
0311-83980152 question their doctors more recovery time :2009-5-29 14:19:54 complaint
Hello, as long as timely symptomatic treatment, at least remission of disease, prolong life is possible.
The response from: Traditional Chinese Medicine Cancer Hospital, Shijiazhuang Fu Shan ã€You have a new perspective on the answers, please 0 Commentsã€‘ timely support for the answer to the reply No comment!
Question their doctors more recovery time :2009-5-29 15:32:55 complaint
If the effective control and timely treatment can prolong life
The response from: NEW cancer: Taxusã€‘ ã€Chinese herbal medicines have a new answer to your point of view of the timely comments, pleaseã€‘ 0 support for the answer to the reply No comment! Experts call for free appointment!
Ni Haiqing, director
Cancer Institute, Chinese herbal medicine Qing Hai
0579-82110111 question their doctors more recovery time :2009-5-31 11:30:35 complaint
Hello, survival time with age, physical
The response from: Cancer Research Institute, Chinese herbal medicine Qing Hai ã€You have a new perspective on the answer you in a timely manner to support the commentsã€‘ 2 people to answer the reply No comment! View more related questions . I want to ask for help! ! How late do not eat liver - 2 times to answer the uterus rectal fossa metastasis of pancreatic cancer - 4 times to answer neuronal ganglion cells - 1 times to answer esophageal cancer - 11 times to answer anti-cancer prescription - 6 times to answer how to do cancer spread? - 8 times to answer