An Examination For Cholangiocarcinoma

1. Laboratory examination

Blood total bilirubin, direct bilirubin, alkaline phosphatase and γ-glutamyltransferase were significantly increased. Aminotransferase generally mild abnormal, this bilirubin, aminotransferase imbalance helps to distinguish from viral hepatitis. Prothrombin time is prolonged. CA19-9 and CEA may be elevated in some patients.

2. Imaging examination

Imaging can be helpful in clarifying the diagnosis of cholangiocarcinoma, knowing whether there are metastases and evaluating whether the tumor can be resected.

(1) Ultrasonic imaging examination

B ultrasound examination is simple, fast, accurate and cost less. It can be found that: ① the intrahepatic and intrahepatic bile duct dilatation; ② Show the obstruction site of biliary tract; ③ The nature of the obstruction. Ultrasound is the first test for obstructive jaundice.

Endoscopic ultrasound can avoid the interference of intestinal gas, and the ultrasonic probe has a high frequency, which can show extrahepatic bile duct tumors more clearly. It has high accuracy in infiltrating deep section of middle and lower segment cholangiocarcinoma and hilar cholangiocarcinoma. Regional lymph node metastasis can also be determined. Direct cholangiography can be performed under guidance, bile can also be extracted by puncture for determination of CA19-9, CEA and bile cytology. Under the guidance of ultrasound, the diseased tissue can be punctured for histological examination. Bile can also be extracted from the site of obstruction for exfoliating cells.

(2) Percutaneous hepatic puncture Cholangiography (PTC)

PTC can clearly show the morphology, distribution and obstruction of bile duct tree inside and outside the liver. The examination is an invasive procedure, and postoperative bleeding and biliary leakage are common and serious complications.

(3) Endoscopic retrograde cholangiopancreatography (ERCP)

ERCP should not be used as a routine test for cholangiocarcinoma, and is even relatively contraindicated. For high level cholangiocarcinoma, percutaneous hepatocentesis cholangiography can show the site of cholangiocarcinoma, or an internal supporting catheter can be placed to reduce yellowing. ERCP has diagnostic significance for lower segment cholangiocarcinoma, which is helpful to distinguish it from duodenal papilla tumor and pancreatic head carcinoma.

(4) CT examination

CT can accurately display the location and scope of bile duct dilation and obstruction, and has a high accuracy in determining the nature of lesions. Three-dimensional spiral CT biliary tract imaging (SCTC) has a tendency to replace PTC and ERCP examination.

(5) Magnetic resonance biliary pancreatic Duct imaging (MRCP)

MRCP examination is a non-invasive biliary tract imaging technique. It is an ideal imaging method for hilar cholangiocarcinoma to show the full picture of the intrahepatic bile duct tree in detail, the site and scope of tumor obstruction, and the presence or absence of hepatic parenchyma invasion or liver metastasis.

(6) nuclide development scanning

By intravenous injection of 99m technetium EHIDA followed by continuous photography with a gamma camera, dynamic images of the biliary tract can be obtained without harm to the patient.

(7) Selective hepatic arteriography and portal venography

The main objective is to understand the relationship between the portal vein and hepatic artery and the tumor as well as the invasion situation, so as to facilitate the preoperative evaluation of the resectable tumor. Digital subtraction imaging (DSA) can show the relationship between the hepatic flow into the hilar and the tumor, which is of significance for the expanded radical operation of cholangiocarcinoma.