Papilloma

Papilloma composed of villi filled with cholesterol esters. Often, this type of tumor arises from cholesterosis. When the X-ray small tumors diagnosed at least 1% of cases. Smooth sidewall diameter up to 1 cm, still. Do not become cancerous.

Adenoma

It is not often diagnosed. This single tumor is localized to the bottom of the body. Asymptomatic and often diagnosed by chance, although separated cells can cause colic zholchnoy. Large adenomas (more than one cm) can degenerate into cancer, so it must be surgically removed.

Carcinoma

Rarely develops in 75% of cases it appears with gallstones or cholecystitis. These diseases are unrelated.

papillary adenocarcinoma

In the first stage is similar to the growth of warts. It is not growing rapidly, and can fill the entire body. When mucous degeneration it is growing rapidly and begins to metastasize early. Share a squamous cell carcinoma, and diffuse infiltrative cancer. Anaplastic type is particularly dangerous.

The tumor grows from the mucosa, but due to the rapid proliferation of set the initial location of the complex. Strong outflow of blood from the gallbladder leads to early metastazam in the lymph nodes. Separates the malignant cells, leading to tumors in the liver, the intestines and the stomach.

Clinical manifestations. Often prone to the disease in women ageOf symptoms: abdominal pain, nausea,Histological examination can detect the presence of carcinoma

In the diagnosis of the doctor can identify dense and even painful education. When blood tests, urine and stool has a similar change of cholestatic jaundice.

The biopsy will show changes related biliary disorders.

When ultrasound at stages 1 tumor can be taken as the wall thickening. In the later stages it can be seen three-dimensional formation, which can fill the body.

Computed tomography can reveal the three-dimensional formation. These methods determine carcinoma in 70% of cases. Unfortunately, when the tumor becomes visible on the diagnostic equipment, the probability that there are already metastases are large, and effective surgery can not help. How common tumor, may suggest an MRI machine.

Only fifty percent of the cases it is possible to establish the disease before surgery.

Forecast

Unfortunately, life expectancy after diagnosis is not great, because by this time the operation is no longer effective. Many patients already have metastases in the body.

Life expectancy - three months after diagnosis. When papillary and highly differentiated adenocarcinoma patients live longer than when the tubular and undifferentiated. Radical surgery also does not give any results. One patient work, and the other does not work.

Therapy

If gallstones cholecystectomy patients produce suggestions. Although this method results are not encouraging. liver resection in this case, proved to be unsatisfactory. Radiotherapy is also not given the increase in life expectancy.

other tumors

In addition to the above can also develop:

  • Leiomyosarcoma.
  • Rhabdomyosarcoma.
  • Carcinoma.
  • Carcinoid.

Non-malignant tumors and cause no symptoms and do not prevent signs until cholangitis and biliary disorders. Before the operation they are infrequent.

Adenomyoma develop in the biliary tract. Grows up to fifteen see Removing her -. The most effective method of treatment.

Fibroma - a small solid tumor, causing the loss of functionality of the bile duct.

Zernistokletochnaya tumor derived from mesenchyme. It is most commonly diagnosed in black women. I treated surgically.

Bile duct carcinoma

This disease is most often diagnosed. Which is explained by the fact that new methods of diagnosis are more accurate.

Carcinoma can be localized in different parts of the body and depend on this method of therapy. Surgery in this case is not effective enough, but it helps to improve quality of life.

Associated with the disease cancer

Cholangiocarcinoma arises with UC and cholangitis. Most often, the cancer develops on the background of sclerosing cholangitis (SC), accompanied by ulcerative colitis.

Of the seventy patients with SH, which was observed in a period of thirty months, fifteen died of liver failure. Of the twelve patients, five were found cholangiocarcinoma.

Risk factors include:

  • Fibrosis.
  • Caroli disease.
  • Multiple cysts.
  • Cirrhosis.

In Asia, China, Korea, Japan, cholangiocarcinoma is twenty percent of the primary malignant liver tumors. They appear with a significant spread of the parasite in the bile ducts.

Opistorhisov (parasite) affecting people who live in Thailand, Malaysia, Laos. They produce carcinogens which cause mutations in DNA that causes cancer.

After cholecystectomy the risk of cancer is reduced, indicating a possible link with cancer gallstones.

Changes in disease

The cancer most often occurs at the confluence of the hepatic and cystic duct and liver hurt. It destroys ducts and provokes an increase in liver. If struck by only one duct, the jaundice does not occur.

Cancer grows around the bile passage and grows through its walls. Identify metastases obtained only fifty percent of cases. Metastases may appear in the liver, lymph nodes, and peritoneum.

molecular level

In this type of cancer, scientists have found a mutation in the twelfth codon oncogene K - ras. With this type of cancer is expressed p53 protein. In cancer, the gate liver a violation of the number of chromosomes, which is accompanied with the penetration of nerve trunks and high mortality.

Clinical manifestations

The disease is most common in male patients older than 55 years. The first signs may be jaundice and itching. If struck only the main duct, the jaundice may occur later.

Average epigastric pain are approximately 1/3 of the cases. There is excess fat in the stool and there is a weakness and weight loss.

Fever appears in the last stage.

The liver is enlarged, with smooth edges, protruding from under the costal arch at 5-12 cm. The spleen is not palpable.

laboratory examination

Biochemistry results suggest cholestatic jaundice.

In no serum mitochondrial antibody, and the level - OP is not elevated.

stool analysis shows that it contains occult blood, fat, and has no color.

Anemia causes of which are not clear. high level of leukocytes, elevated levels of polymorphonuclear leukocytes.

Liver biopsy will help identify damage major bile ducts. Histological examination did not reveal a malignant tumor.

In this case, it is important to make cytology. Brush or a needle biopsy under ultrasound and X-rays are able to detect cancer cells.

Sometimes the cancer is growing level of tumor marker SA19 / 9, but the level may be too high in benign tumors. May be more efficient simultaneous determination SA19 / 9 and carcinoembryonic antigen.

Diagnostics

It is important to ultrasound, because it determines whether the ducts are dilated. In half of cases it is possible to determine the tumor. Ultrasound in combination with a cancer lesion Doppler shows portal vein, but not so effective for the detection of tumors in the hepatic artery. With intraductal endoscopic ultrasound can be found on the site of the tumor in and around the bile duct.

Computed tomography reveals dilated ducts, but it is difficult to determine the tumor itself, since it is the same density as the liver.

MRI shows large cell carcinoma in the liver.

cholangiography

In the study of importance endoscopic or percutaneous cholangiography. This type of diagnosis is carried out in patients having symptoms of cholestasis and extended bile ducts found during ultrasound or computer tomography.

Transpapillary cytology or biopsy during ERCP may reveal a tumor.

Endoscopic retrograde cholangiography helps identify how amazed liver disease gates.

If oncology touched right or left hepatic duct, to determine its location may need to puncture 2x ducts.

Angiography

This method is carried out to determine the operability of the tumor, as it allows you to see the hepatic artery and portal vein, as well as their intrahepatic branches.

If there is a cholestatic jaundice, diagnose - carcinoma.

1 at the screening stage cholestasis is ultrasound. Expansion of the intrahepatic bile ducts - one of the characteristics. The total flow can be subject to changes or with minor modifications. Operate percutaneous or endoscopic cholangiography, cytology and a biopsy to determine the level and stricture parameters.

If the extension of the bile ducts were found in cholestasis, it is necessary to look for other causes of it. These may include jaundice or drug PBC. ERCP should be carried out if these patients do not have the expansion ducts.

Cholangiography reveals strictures of bile ducts caused cholangiocarcinoma.

Forecast

The success of treatment depends on where the tumor is located. At the far location can apply the surgery, but not at the location of the tumor in the liver gate.

The survival rate is higher in patients with differentiated tumors and polypoid cancer.

The mortality rate for one year without surgery is 50 percent, after two years of survival of 20 percent, and after three only 10 percent. From this it is clear that some tumors grow slowly and metastasize late. The problem is not only in malignant tumors, both in its location. If an operation to remove the tumor, the life expectancy of patients is growing.

stage

Before the operation, you should check the general condition of the patient, the possibility of surgery and tumor size. It is necessary to find out whether there are metastases. If the location of the tumor is centered in the middle or lower parts of the body, then the chances of the operation above, but before it is necessary to conduct an angiography to check whether the invasion of blood vessels have undergone.

Most often, doctors are faced with cholangiocarcinoma located at the gates of the liver, which is disappointing diagnosis. The tumor is recognized non-surgical, if there is a loss of hepatic ducts of the two lobes of the liver.

Surgery is performed if one lobe of the liver has struck or squeezing in the hepatic arteries and veins with one hand. Diagnosis is necessary before surgery to determine if the liver is able to function after surgery.

Treatment

Surgery

If the tumor is located in the lower, it can be excised; life expectancy is 70% within one year. At the proximal location of the tumor is removed together with liver lobes.

Doctors recommend removing the caudate lobe, as its 2-3 bile duct empty into the hepatic ducts, in connection with which there is a risk of cancer.

The complexity of the operation that had to be removed a tumor while preserving as much healthy tissue as possible. After surgery, patients live two to three years, the patients feel well. When local surgery tumor types 1 and 2 Bismuth mortality no more than five%. In type 3 the mortality rate is much higher, and there are a lot of complications.

Liver transplantation in cancer is not effective, since there is a high risk of relapse after surgery.

For palliative care include the connection of the small intestine with a channel 3 segment of the left lobe. In 75% of the doctors can not cope with jaundice.

Palliative therapies

If the tumor is inoperable, the symptoms can be removed, such as jaundice and itching using endoscopic or percutaneous stent placement.

This method is successful in ninety% of cases. Additional complications can be noted - cholangitis (7%). Mortality within thirty days of from 10 to 28%.

Percutaneous transhepatic stenting is also effective, but has risks of complications: bleeding or expiration of bile.

When palliative surgery and non-surgical methods have not been compared. Both methods have their pros. If the mortality rate is high, the non-surgical methods are used.

The combination of bile drainage paths internal radiotherapy. But it is not known how effective this method is. Application of cytostatics does not give any advantage. The effectiveness of remote radiotherapy, also not confirmed.

cholangiocellular carcinoma

It develops from intrahepatic biliary relates to primary hepatic carcinoma. Symptoms appear as the swelling increases. Patients often complain of not jaundice and abdominal pain. This type of cancer has the best prognosis, as growing quite rapidly and begins to metastasize. Operation - one of the most effective therapies. After the surgery, life expectancy is on average 13 months after transplantation - 5 months.


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