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A pathway for patients with cholangiocarcinoma

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A pathway for patients with cholangiocarcinoma

5,400 diagnoses a year, 14% more cases in 2020 than in 2015 and an average 5-year survival of less than 20%, which triples to 50% if the diagnosis is timely. It is cholangiocarcinoma, a tumor that develops in the cells of the bile ducts (cholangiocytes, hence the name) and also one of the most complex, rare and aggressive forms of cancer. This is why it is a neoplasm that more than others requires a decisive, multidisciplinary and ‘expert’ management of patients.

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“The scarcity of symptoms in the initial stage of the disease and the lack of certain risk factors explain why cholangiocarcinoma is diagnosed in the advanced stage in 70% of cases and why it is so difficult to cure it,” Felice Giuliante, director of General Surgery, told Oncoline and hepato-biliary as co-coordinator of the Cholangiocarcinoma Path developed by the Agostino Gemelli IRCCS University Hospital Foundation of Rome, just presented in Rome. ā€œAfter the diagnosis – continues Giuliante – surgical removal is possible only for 15-20% of patients, and in these cases the treatment can be decisive. This is why, even in a high-volume center like our hepato-biliary surgery, of the approximately two thousand liver resections performed in the last 10 years, only 15% concern cholangiocarcinomas”.

The importance of taking charge

For all other cases, multidisciplinary management becomes fundamental: a path that includes the hepatobiliary surgeon, the oncologist, the radiotherapist, the endoscopist, the gastroenterologist, the radiologist, the nutritionist, the psychologist. Even better if with a single access door, which guarantees appropriate and timely management, through multidisciplinary assessment. As happens in the multidisciplinary clinical-care path of the Gemelli, which can be accessed both through the ‘Gemini-Cancer Desk’ and through the emergency room.

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Even 2022

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Signs and risk factors

Cholangiocarcinoma affects the biliary tract and can be both internal to the liver (intrahepatic cholangiocarcinoma) and extrahepatic. It is an insidious tumour: in one out of 4 cases intrahepatic cholangiocarcinoma is diagnosed ‘by chance’, i.e. on the occasion of tests prescribed for other pathologies, while for extrahepatic forms the alarm is often given by the appearance of jaundice.

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Among the risk factors are diseases of the biliary tract (sclerosing cholangitis, intrahepatic calculi, congenital dilatation of the biliary tract). Metabolic syndrome, chronic liver disease, liver cirrhosis can also help increase the likelihood of getting sick: one in 2 patients with cholangiocarcinoma is also affected by one of these diseases. In any case, it is really difficult to identify a population to monitor.

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An increase in cases still without explanation

ā€œGemelli is one of the reference centers where cholangiocarcinoma, although it is a rare disease, is as if it weren’t so due to the number of cases that are treated ā€“ reasons Giuliante -. Weekly meetings dedicated to this tumor have been held for years, and it is precisely during these meetings that we have observed that the cases of cholangiocarcinoma have increased”. We still have no answers as to the reasons for these increases. “However – concludes Giuliante – we have hope: thanks to molecular profiling and the construction of large data registers, and thanks to innovative therapies with a molecular target, we will be increasingly able to reduce tumor masses and extend the possibility of surgery to a number more and more patients”.

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