Webinar: What Patients Need to Know About Hilar Cholangiocarcinoma and Liver Transplant

Tue, Aug 11, 2015
12:00pm to 1:00pm ET

Description

Julie Heimbach, MD, Liver Transplant Program Surgical Director, and Sumera Rizvi, MBBS, Gastroenterology and Hepatology Fellow, discuss hilar cholangiocarcinoma symptoms, diagnosis, and treatment options, including liver transplantation. Questions were answered following during the presentation.

This webinar on hilar cholangiocarcinoma (cancer of the bile ducts) was recorded, Aug. 11 2015.

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Will they ever consider paired donors like they do with kidneys? Instead of knowing your living donor.

@unified

Will they ever consider paired donors like they do with kidneys? Instead of knowing your living donor.

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Yes—this may be a consideration as centers get more experience with living liver donation.

@1winddancer

I was diagnosed with IDPMN about 20 no the ago via ESU . They also said I have 6 precancerous pancreatic cysts thru out the pancreas. How worried should I be?

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This depends on the size and endoscopic ultrasound characteristics of the pancreatic cysts. Recent guidelines have been published by the American Gastroenterology Association (http://www.gastrojournal.org/article/S0016-5085(15)00100-6/abstract). You can review these with your local physician to ensure that appropriate follow-up occurs.

Question from Periscrope: Is chemotherapy for bile duct cancer useless?

@LaurenSpiceland

Question from Periscrope: Is chemotherapy for bile duct cancer useless?

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Selected patients derive benefit from chemotherapy for cholangiocarcinoma or bile duct cancer. However, the results are often non-durable. Further studies are necessary to identify medical therapies that are more effective.

Question from Periscope: What about enhanced recovery/fast track programs and cholangiocarcinoma?

@LaurenSpiceland

Question from Periscope: What about enhanced recovery/fast track programs and cholangiocarcinoma?

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Regarding recovery following liver transplantation or surgical resection for cholangiocarcinoma, protocols which are helpful for fast recovery of patients with abdominal surgery would also pertain to patients with cholangiocarcinoma. We have these protocols in place for our patients at Mayo Clinic, and likely at other centers as well.

Question from Periscope: I’ve had multiple pancreatic and cbd surgeries. Am I at risk for cancer of my cbd?

@LaurenSpiceland

Question from Periscope: I’ve had multiple pancreatic and cbd surgeries. Am I at risk for cancer of my cbd?

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Purely from the standpoint of having had bile duct surgery, the overall risk of developing bile duct cancer is low. The risk would depend upon the underlying condition for which the surgery was performed. It may be higher risk for patients with a history of choledochal cysts depending on the type of surgery that was performed.

Should I have an ERCP to see if I have cancer?
IMPRESSION:
1. Findings within the liver and biliary tree consistent with
patient’s history of primary sclerosing cholangitis. There is
enhancement and thickening of the biliary tree in the hilar region.
Cholangiocarcinoma cannot be excluded.
2. Prominent periportal lymph nodes.

DISCUSSION: Abdominal MRCP performed before and after the
intravenous administration of 14 mL MultiHance. Comparison is made
to CT dated 12/22/2010. Indication is PSC.

Imaging through the abdomen shows mild abnormal liver morphology
which is likely due to patient’s underlying biliary tree disease.
There is mild irregularity of the biliary tree with dilated intra and
extrahepatic bile ducts which show narrowing in the hilar region
where there is thickening of the biliary tree and prominent
enhancement. The intrahepatic duct dilation is increased since the
2010 exam. Cholangiocarcinoma cannot be excluded. The branch of the
right hepatic artery courses posterior to the thickening at the
hilum. The hilar thickening is just anterior to the portal vein
bifurcation. Hepatic veins are normal. The gallbladder is
surgically absent. The spleen is normal in size. Kidneys and
adrenal glands are normal. The pancreas and pancreatic duct are
normal. No ascites. There are prominent periportal lymph node

@liljeanie

Should I have an ERCP to see if I have cancer?
IMPRESSION:
1. Findings within the liver and biliary tree consistent with
patient’s history of primary sclerosing cholangitis. There is
enhancement and thickening of the biliary tree in the hilar region.
Cholangiocarcinoma cannot be excluded.
2. Prominent periportal lymph nodes.

DISCUSSION: Abdominal MRCP performed before and after the
intravenous administration of 14 mL MultiHance. Comparison is made
to CT dated 12/22/2010. Indication is PSC.

Imaging through the abdomen shows mild abnormal liver morphology
which is likely due to patient’s underlying biliary tree disease.
There is mild irregularity of the biliary tree with dilated intra and
extrahepatic bile ducts which show narrowing in the hilar region
where there is thickening of the biliary tree and prominent
enhancement. The intrahepatic duct dilation is increased since the
2010 exam. Cholangiocarcinoma cannot be excluded. The branch of the
right hepatic artery courses posterior to the thickening at the
hilum. The hilar thickening is just anterior to the portal vein
bifurcation. Hepatic veins are normal. The gallbladder is
surgically absent. The spleen is normal in size. Kidneys and
adrenal glands are normal. The pancreas and pancreatic duct are
normal. No ascites. There are prominent periportal lymph node

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Our doctors are now longer taking questions from this webinar. You might try posting your question on our Connect transplant or cancer pages: https://connect.mayoclinic.org/group/transplants/ and https://connect.mayoclinic.org/group/cancer/. Someone with a similar experience may have some insight. Or, you can visit this page to learn more about making an appointment at Mayo Clinic: http://www.mayoclinic.org/appointments.

Best of luck!

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