Diagnostic and Therapeutic Algorithms for Cholangiocarcinoma

Cholangiocarcinoa (CC) is a challenging disease, most patients presenting with unresectable tumours at the time of diagnosis. Imaging techniques (US, CT, MRI) and invasive tests (ERC or EUS with brushing and FNA or biopsy US or TC guided) with a pathological confirmation are required to establish a definitive diagnosis of CC. The ultimate curative treatment strategy for CC is surgery. Thus, a multidisciplinary team in a referaal centre should first expolre the surgical option and distinguish resectable from unresectable disease. Secondly, in both situations it is necessary to screen patients with jaundice which may required decompression of the biliary tract with drainage/stent function is essential to minimize the risk of postoperative liver falilure. If future liver failure is suspected, portal vein embolization or an associating liver partition and portal vein ligation for staged hepatectomy should be considered. Surgery could lead to a curative resection and so an adjuvant tharapy may be administered. Otherwise, after a non-curative resection or in unresectable locally advances metastatic or recurrent cholangiocarcinoma first-line chemotherapy is the suggested option, possibly associated with radiotherapy or locoregional treatmens. Whne the disease is no longer controlled by any line of chemotherapy, best supportive care should be suggested.