Klatskin Tumor
Klatskin tumor is malignant cholangiocarcinoma arising from extrahepatic bile duct near the confluence of left and right hepatic ducts. It is hilar carcinoma. [1]
Epidemiology and Etiology[edit | edit source]
Klatskin tumor is quite rare, more in male sex in age > 60 years.[1] There is prooved connection between this malignant tumor and primary sclerosis cholangitis (autoimmune disease) and parasitic infection in biliary ducts (Clonorchis sinensis and Opisthorchis viverrini, both in Southeast Asia).
Pathology[edit | edit source]
It is cholangioccarcinoma (usually cylindrocellular adenocarcinoma) in more than 90% of cases, grows slowly, is locally agressive – can penetrate to portal vein, hepatic artery, liver parenchym. Metastasise quite late (lymph nodes in porta hepatis, liver).[1]
For more information see Cholangiocarcinoma.- Bismuth classification
hepatic ducts anatomy 
Clinical Features[edit | edit source]
Symptomes are very similar to pancreatic head cancer:
- painless obstructive jaundice, possible Courvoisier sign;
- abdominal pain;
- weight loss.[2]
Diagnostic Methods[2][edit | edit source]
- lab: higher bilirubin, tumormarker CA 19-9 (but is not specific, can be found in patients with colon cancer, pancreatic cancer or biliary obstruction);
- USG: possible biliary duct dilatation, gallbladder dilatation;
- EUSG: through the wall of the stomach or duodenum is possible find the tumor;
- MRCP: is prefered more than ERCP, because MRCP is noninvasive methode which can show stage of tumor process;
- ERCP (endoscopic retrograde cholangio-pancreatography) should be prefered only if there is no MRCP examination possible or is neccesary therapeutic intervention of biliary obstruction (stent);
- CT: computer tomography is always neccesary in staging, results of CT will decide about the therapy, should be always performed before ERCP (because we need to have images before intervention)!
Classification[edit | edit source]
TNM Classification[3][edit | edit source]
- Tis – carcinoma in situ;
- T1 – tumor is in muscular layer of biliar duct;
- T2a – tumor penetrates to lipid tissue;
- T2b – tumor petetrates to liver parenchym;
- T3 – tumor penetrates to left or right portal vein or left or right hepatic artery;
- T4 – tumor penetrates to portal vein, or left and right portal vein, or common hepatic artery, ...
For more information see TNM.| STAGE | T | N | M |
| Stage 0 | Tis | N0 | M0 |
| Stage I | T1 | N0 | M0 |
| Stage II | T2a, T2b | N0 | M0 |
| Stage IIIa | T3 | N0 | M0 |
| Stage IIIb | T1, T2, T3 | N1 | M0 |
| Stage IVa | T4 | N0, N1 | M0 |
| Stage IVb | T1-T4 | N0, N1 | M1 |
Bismuth Classification[edit | edit source]
is based on tomor’s localization in extrahapatic biliary tree:
- Bismuth I – tumor of common hepatic duct, not reaching the junction;
- Bismuth II – tumor of common hepatic duct, reaching the junction;
- Bismuth III – tumor of common hepatic duct and left or right hepatic duct;
- Bismuth IV – tumor of common hepatic duct and left ahd right hepatic duct.
Therapy[edit | edit source]
Curative Therapy[edit | edit source]
Only radical tumor resection can be curative and should be performed only in stage I or II of TNM classification. It is extensive surgery with bile duct and right liver lobe (or extend right liver lobe) resection and hepaticojejunoanastomosis (Roux Y-loop).
Paliative Therapy[edit | edit source]
In nonoperable tumors (TNM stage III and IV) is chemotherapy performed. Usually gemcitabine (nukleosid analogue) and cisplatin. Average survival time is 8.5 months.[4]
Paliative therapy is based on hepatic ducts patency (drainage of bile):
- internal drainage – (metalic) stent via ERCP;
- external drainage – PTD (percutaneous transhepatic drainage).
Last but not least is therapy of pain.
Links[edit | edit source]
Related articles[edit | edit source]
References[edit | edit source]
- ↑ a b c POVÝŠIL, Ctibor, et al. Speciální patologie. 2. edition. Prague : Galén, 2007. pp. 199. ISBN 978-80-7262-494-2.
- ↑ a b BURKITT, H. George – QUICK, Clive R. G. Essential surgery : problems, diagnosis and management. 4. edition. Edinburgh ; New York : Churchill Livingstone, 2007. 793 pp. pp. 369-373. ISBN 9780443103469.
- ↑ SOBIN, L.H – GOSPODAROWITZ, M.K – WITTEKIND, Ch. TNM : Classification of Malignent Tumors. 7. edition. 2009. ISBN 978-80-904259-6-5.
- ↑ ŠMAKAL, Martin. Komplexní léčení nádorů - role onkologa [lecture for subject Surgery, specialization Surgery, 1. LF UK Charles University in Prague]. Prague. 2011-10-21.
