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Work-up
Early diagnosis of gallbladder or cholangiocellular carcinoma is nearly impossible or can be realized only in exceptional cases
In a patient with specific clinical symptoms or ultrasound suspicion of biliary tract cancer, a spiral CT and chest x-ray should be performed
Medically fit, nonjaundiced patients whose disease appears potentially resectable may proceed directly to surgical exploration without needle biopsy to avoid tumor spread. Consider a laparoscopic evaluation before open surgery owing to the common occurrence of otherwise nonvisible metastatic spread to the peritoneum
If the potential to perform a resection remains uncertain and for those with jaundice, a more precise assessment of tumor extent and lymph node involvement should be obtained with MRCP ± MRA, which may help to rule out vascular invasion and anomalous anatomic findings for surgical planning
If it is obvious that a resection will not be possible or if distant metastases are present, fine-needle biopsy for tissue confirmation should be obtained
In nonresectable jaundiced patients, depending on the location of the biliary obstruction, a percutaneous transhepatic cholangiography (PTC) or an endoscopic retrograde cholangiography (ERC) should be considered to guide placement of a stent
Fong Y et al. Cancer of the liver and biliary tree. In: Principles and Practice of Oncology, 6th ed. Baltimore, MD: Lippincott Williams & Wilkins 2001:1162–1203
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Five-Year Survival (Intrahepatic Cholangiocarcinoma)
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Staging Gallbladder Cancer