ABSTRACT
Tumours of the biliary tract can be divided into those of the intra-hepatic bile ducts, extra-hepatic bile ducts and gall bladder. Environmental, genetic and anatomic predisposing factors have been associated with the development of cholangiocarcinomas. Anatomic factors include the presence of fibrocystic disease of the liver choledochal cysts and biliary papillomatosis and abnormal pancreatico-biliary duct junction. A high index of suspicion and a multidisciplinary investigative approach are required, especially in patients with primary sclerosing cholangitis who already have dominant biliary strictures and deranged liver function with secondary biliary cirrhosis. Laparoscopy can detect small-volume peritoneal disease or liver secondaries missed in cross-sectional imaging, although it is less accurate for vascular invasion, lymph node involvement and extent of biliary spread. Cancers of the bile duct and gall bladder remain difficult tumours to diagnose and treat effectively. Improvements in the outcome of surgical resection have caused this approach to be re-evaluated.
