ABSTRACT
Biliary tract neoplasms account for 1% to 2% of all cases of cancer, with only approximately 7000 cases presenting in the United States annually. They include intrahepatic, perihilar, and distal cholangiocarcinomas (∼20-25%, 50-60%, and 20-25% of cases, respectively), and gallbladder carcinomas, the more common of the two types (1). More than 95% of cases are adenocarcinomas, often well-differentiated and mucin-producing, with lymph node metastases, peritoneal and distant metastases, and multifocal or diffuse involvement of the biliary tree in 50%, 10% to 20%, and 5% of all patients atpresentation, respectively (1,2). Poor prognosis and difficulties with clinical management are due to frequent late-stage diagnosis, advanced age at presentation [two-thirds of all cases occurring in patients older than 65 years (1,3)], the low diagnostic yield of biliary cytology, the technical demands of radical surgery (usually requiring hepatectomy or pancre aticoduodenectomy), and the lack of standard neoadjuvant, adjuvant, and palliative chemo-/ radiotherapy. However, advances in imaging now allow for earlier diagnosis of biliary tract neoplasms and better surgical or palliative biliary stent planning, and newer combination chemotherapy regimens may improve patients’ survival and quality-of-life.
