Editing Cholangiocarcinoma (section)

== '''Distal CBD cancer''' ==

=== Presentation ===

** Similar to other periampullary tumours - painless jaundice and constitutional symptoms

=== Workup ===

** Pancreas protocol CT
*** Arterial anatomy, regional lymphatic spread, relationship of tumour to nearby vascular structures
*** Secondary pancreatic signs of periampullary malignancy such as atrophy or ductal dilatation
** ERCP - can be used as a diagnostic modality, but not recommended routinely because it colonises the biliary tree with enteric organisms and increases rate of infectious complications after whipples procedure
** Don't need to fix jaundice pre-operatively because not doing a major hepatectomy

=== Staging ===
'''Distal bile duct cancer TNM staging AJCC UICC 8th edition - to follow'''


=== Management ===

** Resection
*** Pancreaticoduodenectomy
**** Increasingly done lap/robotic
*** Frozen section of the proximal bile duct margin helps ensure R0 resection