In addition to hepatogenic bile duct carcinoma, cholangiocarcinoma may also be a result of chronic inflammation caused by infection or chronic liver disease, especially with the association of gallbladder cancer.
The number of new annual CCA cases is estimated to be around 8,000 per year in the United States. In terms of proportion, the National Institutes of Health (NIH) estimates that around 6.6% of all people with non-kaposi's sialadenitis will develop a CCA.
Cholangiocarcinoma presents early and can be easily diagnosed. It is advisable to diagnose cholangiocarcinoma as early as possible, and treatment should be started at a reasonable time so that the cancer can be cured completely. Moreover, it is important to monitor patients for signs of recurrence after removing the cancer completely.
Even if radical surgical resection is considered as cure, recurrences have been reported in some cases following curative surgery. These have also been reported as failures in others. Even if radical surgery can eradicate cholangiocarcinoma, it appears that the disease may re-emerge in the remnant liver following post-surgical remission. New therapies and strategies to control the tumor in the remnant liver are necessary.
Cholangiocarcinoma is the sixth most common cancer of the bile duct and accounts for 15% of the malignant intrahepatic bile duct neoplasms. It is a neoplasm that forms when bile duct epithelial cells become malignant. cholangiocarcinoma most commonly occurs at 35 to 65 years of age and is more common in men than in women. The median survival postdiagnosis is less than 2 years. It has a poor prognosis after curative surgery and patients will need to be monitored after surgery for recurrence.
Treatment for cholangiocarcinoma should be tailored to the individual patient. The first potential treatment for cholangiocarcinoma (BCLC stage B) is biliary drainage, i.e., biliary tract obstruction. Surgical resection is recommended when the tumor is resectable (BCLC stage A and T3). Liver transplantation should also be considered for advanced cases. Postoperative adjuvant chemotherapy may improve local and regional control for recurrence in T3 stages T1 and T2 cancers. For BLCC stage C, radiotherapy is a key treatment modality. For all stages, systemic treatment of CCA with chemotherapy and cytotoxic agents is also encouraged.
Recent findings suggest that, even if complete surgical resection is achieved for patients with CCA, a local recurrence or distant metastasis of CCA will always occur. Hence, the ultimate outcome of this rare malignancy has not improved appreciably even with modern surgical techniques and postoperative adjuvant therapy.
Niraparib did not significantly improve global QoL or bothersome symptoms in patients with cholangiocarcinoma. However, an analysis on the specific domains suggested that specific symptoms such as fatigue and nausea were improved. Data from a recent study support the use of niraparib for the treatment of refractory cholangiocarcinoma.
The prevalence of cholangiocarcinoma among males is more than six times of that among females in Taiwan. The peak age of cholangiocarcinomas is over 65 years of age, but still far lower than that found in Western populations.
There is an improvement in survival over the last 10 years. Patients who do not have distant metastasis have a greater chance of survival than those with distant metastases. Patients who have resection or lymph node irradiation have a significantly longer survival. Therefore, there is an ongoing battle between the extent of surgery, the amount of chemotherapy and the amount of radiation that the patient receives. Nevertheless, a long-term survival can be achieved.
Niraparib is an option for first-line treatment of patients with metastatic or adjuvant ovarian cancer and may benefit patients with gastrointestinal stromal tumours due to its ability to target both Hsp-90 and IGF-1Rs. These preliminary data suggest that there is an acceptable safety profile for niraparib in patients with gastrointestinal stromal tumours although these studies represent preliminary data.
Niraparib has completed a pivotal clinical trial in advanced [metastatic breast cancer](https://www.withpower.com/clinical-trials/metastatic-breast-cancer) and is one of the most effective chemotherapeutic drugs currently available to patients with metastatic breast cancer. The use of niraparib combined with the anticancer agent trastuzumab, a molecule that targets and inhibits HER2 receptors, has shown significant antitumor effects in patients with untreated metastatic breast carcinoma. However, due to the occurrence of serious adverse effects during the treatment of a subset of patients, niraparib is not an approved drug in many countries, including the United States.