Overview of Bile Tract Tumors
Biliary tract tumors mainly refer to tumors originated from biliary system, including gallbladder tumors and bile duct tumors, which are classified into benign and malignant tumors. Biliary tract malignant tumors rank 5th among the gastrointestinal tract tumors in China, and the most common one is gallbladder cancer, which accounts for about 1/3 of the biliary tract tumors, and gallbladder cancer is most common in elderly women aged 50 to 70.
Etiology
The etiology is not completely clear, and it is considered to be related to stones.
Symptoms
Biliary tract tumors are usually asymptomatic in early stage, and only found accidentally during physical examination or surgery. If there are symptoms, they mostly manifest as vague pain in the right upper abdomen, which may be aggravated by paroxysms, radiating to the right shoulder and lumbar back, or manifesting as dyspepsia, anorexia, belching, abdominal distension, and so on.
1. Benign tumor of gallbladder
Benign tumors of the gallbladder may be found as polyps or adenomas in the resected gallbladder specimen, while polyps are not true tumors and true adenomas account for about 4% of benign lesions. Benign gallbladder mucosal lesions include cholesterol polyps, inflammatory polyps, adenomatous polyps, adenomyosis, or adenomyoma. Cholesterol polyps are generally small, <1 cm in diameter, and are tipped and often multiple. The detached cholesterol polyps can cause biliary colic and acute pancreatitis when they are discharged through Oddi’s sphincter.
2. Gallbladder cancer
Gallbladder cancer mostly occurs in the gallbladder body or the bottom of the gallbladder and is mostly adenocarcinoma, which can be divided into invasive carcinoma and papillary carcinoma. In infiltrating carcinoma, the wall of gallbladder is diffusely thickened, and in some cases, the cavity of gallbladder is filled with mucus; in papillary carcinoma, it can be seen as villous or cauliflower-like mass, which can block the outlet of gallbladder, and the tumor can be hemorrhagic and necrotic, and the cavity of gallbladder can be enlarged. There is no typical and specific clinical symptom of gallbladder cancer, but when combined with stones or inflammation, it may manifest as dyspepsia, anorexia, belching, abdominal distension and so on.
3. Bile duct cancer
(1) Hepatoportal cholangiocarcinoma: it can be manifested as progressive aggravation of obstructive jaundice, dilatation of intrahepatic bile ducts, gallbladder atrophy, hepatoportal mass and so on. Hepatoportal cholangiocarcinoma is classified into papillary, nodular, sclerosing and diffuse cholangiocarcinoma according to pathological features. Papillary cholangiocarcinoma mainly grows into the lumen of the bile duct, does not infiltrate into the tissues around the bile duct, and does not invade the blood vessels and lymphatic space around the nerves; nodular cholangiocarcinoma grows slowly and is well differentiated; sclerosing cholangiocarcinoma has a tendency to invade outside the bile duct and invade the lymphatic space around the nerves, and is prone to recur in the localized area after surgical resection, which is the most common type of this kind of cancer; diffuse cholangiocarcinoma has a wide expansion in the direction of upward and downward of the bile duct, and is rapid in development.
(2) Middle cholangiocarcinoma: jaundice, obstruction of choledochal duct, gallbladder effusion appear earlier, and in late stage, it can invade adjacent tissues, portal vein and hepatic artery.
(3) Lower bile duct cancer: clinical symptoms mainly include obstructive jaundice, skin itching, weight loss, enlarged gallbladder and hepatomegaly.
Examination
Ultrasonography can show the degree of dilatation of intrahepatic bile ducts, whether the extrahepatic bile ducts are dilated or not, the size of gallbladder, the size and location of gallbladder tumors, CT and magnetic resonance imaging are also similar to B-ultrasonography, which can be used for auxiliary diagnosis of tumors.
Diagnosis
Diagnosis depends on the localization of the tumor by imaging and the characterization of the tumor by histopathological examination, so as to differentiate it from other diseases.
Treatment
Surgery is the mainstay of treatment. Since early detection and diagnosis of these diseases are difficult, the prognosis is poor.