Cholangiocarcinoma: emerging approaches to a challenging cancer.
OBJECTIVE
Cholangiocarcinomas are malignancies arising from biliary tract epithelia that are associated with a poor prognosis. The diagnosis, evaluation and management of these tumors continue to be clinically challenging. In this review, we will discuss recent information that may influence the approach to the diagnosis and management of this devastating tumor.


RESULTS
Epidemiological studies are defining patient groups at increased risk of cancer in regions of low prevalence. Emerging approaches that may improve evaluation and management include the potential use of genomic and proteomic markers, cytogenetic and digital image analysis, endoscopic ultrasound with fine needle aspiration, and cholangioscopy. Adoption of aggressive surgical approaches along with the use of preoperative portal vein embolization, hepatic and caudate lobe resection and preoperative laparoscopy may improve survival.


CONCLUSIONS
Recent conceptual and technical advances will impact the clinical approach to cholangiocarcinoma and offer the promise of improving outcomes from this difficult tumor.
Patel
Tushar
T
Department of Internal Medicine,Scott and White Clinic, Texas A&M University Health Science Center, Temple, TX 76508, USA. tpatel@swmail.sw.org
Singh
Pankaj
P
D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D003131:Combined Modality Therapy; D014943:Global Health; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D009017:Morbidity / Q000639:trends; D049268:Positron-Emission Tomography; D011379:Prognosis; D014057:Tomography, X-Ray Computed