Multidisciplinary management and the future of treatment in cholangiocarcinoma

Introduction: Cholangiocarcinoma is an often lethal and relatively rare cancer that arises from the epithelial lining of the biliary tree. Disease can arise throughout the liver, at the confluence of the right and left main hepatic ducts, or as the common bile duct runs toward the ampulla of Vater. Cholangiocarcinoma has a distinct geographic variability with the greatest incidence in the Far East. Worldwide, the incidence of cholangiocarcinoma appears to be increasing. Areas covered: In this review, a comprehensive search of the peer-reviewed literature is completed to provide an update regarding the diagnostic adjuncts, clinical management, and areas of active research for this disease. There are no reliable screening tools available for clinical detection. Surgery is the only chance for cure. Chemotherapy is often used in the adjuvant setting or in patients with unresectable disease, though outcomes are generally poor. Newer approaches that include hepatic artery-based therapies and image guided radiation therapy appear to provide limited survival benefit. Expert opinion: Maximizing survival following a diagnosis of cholangiocarcinoma relies on a multidisciplinary team of experts in medical oncology, radiation oncology, surgical oncology (principally hepatopancreatobiliary surgeons), and interventional radiology.