Treatment of Bile Duct Tumors or Klatskin Tumors
Best hospitals and doctors for cholangiocarcinoma (klatskin tumor) treatment abroad
Leading hospitals
Cost for treatment
Bile duct cancer includes a group of tumors developing from the epithelium of the biliary tract (usually right and left hepatic ducts) that are referred to as Klatskin tumors or cholangiocarcinomas.
Content
- Overview
- Klatskin tumors
- Symptoms
- Diagnostics
- Treatment
- Where can I undergo bile duct cancer treatment abroad?
- The cost of treatment abroad
- How can I undergo bile duct cancer treatment abroad?
Overview
Cholangiocarcinoma is the most common malignant tumor of the bile duct and primary liver tumor after hepatocellular carcinoma. The common hepatic duct serves as the site of the division of cholangiocarcinomas into the intrahepatic and the extrahepatic ones, and the cystic duct is the border separating these two subtypes from the distal cholangiocarcinoma. In the structure of cellular cholangiocarcinoma, portal cholangiocarcinoma (hilar cholangiocarcinoma or Klatskin tumor) occupies half of all cholangiocarcinoma cases, while the intrahepatic form occupies only 8% of all cholangiocarcinoma cases.
Klatskin tumors
In 1946, Dr. Klatskin founded the laboratory, which eventually became known as the department for the study of the hepatobiliary system. In 1965, he described the unique features of hilar cholangiocarcinoma, which bears his name since.
Depending on the localization, the incidence of cholangiocellular cancer varies from 1 to 7 cases per 100,000 population, and 40-60% of all cases are related to the Klatskin tumor.
Histologically, Klatskin tumor or hilar cholangiocarcinoma in most cases is a highly or moderately differentiated adenocarcinoma with slow growth, metastases in the lymph nodes, relatively late hematogenous metastasizing, longitudinal and radial spreading along the bile duct and into the depth of its wall. Due to the sub-epithelial growth of the Klatskin tumor (hilar cholangiocarcinoma) along the bile duct under the externally healthy mucous membrane, the actual spreading of tumor cells may exceed the macroscopically visible lesion by 5-10 mm, which significantly complicates the possibility of its surgical treatment.
Klatskin tumors or hilar cholangiocarcinomas usually appear at the age of 50-70 and, according to statistics, are somewhat more common in men. Patients usually do not experience any symptoms until the advanced stages of the disease, where jaundice is the main manifestation. Abdominal pain, weight loss, and malaise are other symptoms that some patients experience. Metastasizing to regional lymph nodes is common.
In 90% of cases, Klatskin tumors appear sporadically, but certain risk factors are still associated with this disease. These risk factors include primary sclerosing cholangitis, secondary sclerosing cholangitis, chronic typhoid fever, parasitic infections, and all the choledochus cysts (bile duct cysts) that cause chronic inflammation of the hepatobiliary system.
The main goals of treatment are the relief of biliary block and tumor resection. As Klatskin tumors (hilar cholangiocarcinomas) are generally resistant to chemotherapy and radiation therapy, surgical resection is the only efficient treatment, but this option is not always suitable for patients with advanced disease stages.
Surgical treatment involves liver resection with caudal lobectomy, which is more likely to reach the negative margin of the tumor.
Unresectable Klatskin tumors are treated with radiation therapy and/or chemotherapy. Gemcitabine in combination with cisplatin therapy has been recognized as the standard treatment for patients with unresectable biliary tract tumors, including Klatskin tumors (hilar cholangiocarcinomas).
Klatskin tumor is the cholangiocarcinoma located at the confluence of hepatic bile ducts.
Best treatments for bile duct cancer are surgery and endovascular treatment (chemoembolization).
The leading hospitals in Europe are Academic Hospital of the Brothers of Mercy and University Hospital of the University of Munich Ludwig Maximilian (Germany).
Prices are as follows:
| Procedure | Cost |
| Partial hepatectomy | from 22,269 € |
| ERCP and bougienage | from 4,041 € |
| Chemotherapy | from 2,405 € |
Symptoms
Biliary tract cancer includes:
- Cancer of the intrahepatic biliary tract
- Cancer of the extrahepatic biliary tract – Klatskin tumor (hilar cholangiocarcinoma)
Cholangiocarcinoma and other tumors of the bile duct are rare (1-2 cases per 100,000 people), but are usually malignant. Cholangiocarcinoma mainly affects the extrahepatic type of the bile ducts: 60-70% of cases occur in the area of the liver hilum (Klatskin tumor), about 25% – in the distal segments of the bile ducts, in other cases, other liver parts are affected. It is believed that tumors of the biliary tract account for about 3% of all tumors of the gastrointestinal tract, while intrahepatic cholangiocarcinomas account for about 10% of cases of primary liver cancer. Among cholangiocarcinomas, Klatskin tumor accounts for 50% of cases, 40% of which are the tumors of distal localization.
Tumors with damage to the bile ducts are related to tumors of extrahepatic localization (Klatskin tumor).
Most patients with cholangiocarcinoma deal with painless obstructive jaundice, usually between the ages of 50-70. Early stage tumors located at the hilum of the liver can only cause abdominal pain, anorexia, and weight loss. Other symptoms may include fatigue, acholic stools (usually indicate jaundice), hepatomegaly (enlarged liver), or an enlarged gallbladder (Courvoisier's symptom in distal cholangiocarcinoma). Pain may resemble biliary colic (reflects biliary obstruction) and be persistent or progressive. Sepsis (with acute cholangitis) is not a typical complication but may be confirmed or excluded with endoscopic retrograde cholangiopancreatography.
Risk factors include age, presence of primary sclerosing cholangitis, hepatic fluke invasion, and cysts in the bile duct.
Diagnostics
Methods that are used for the confirmation of cholangiocarcinoma diagnosis in European hospitals include:
- Ultrasonography (sometimes endoscopic ultrasonography) followed by CT cholangiography or magnetic resonance cholangiopancreatography
- Endoscopic retrograde cholangiopancreatography, if indicated
Cholangiocarcinomas are suspected in cases of unexplained obstruction of the bile ducts. In patients with primary sclerosing cholangitis, levels of carcinoembryonic antigen (CEA) and cancer antigen CA-19-9 in the blood are examined to exclude cholangiocarcinoma presence.
CT scan is often done, which can provide more information than ultrasonography, especially in the diagnosis of cholangiocarcinomas. If these methods do not provide a doctor with the sufficient information about the disease, then endoscopic retrograde cholangiopancreatography with percutaneous transhepatic cholangiography is performed. Endoscopic retrograde cholangiopancreatography allows not only detecting a tumor but also performing a biopsy to confirm the diagnosis. CT scan with a contrast agent also helps in determining the stage of the disease.
Open laparotomy is sometimes used in European hospitals to determine the spreading of the pathological process, which makes it possible to choose the most suitable therapeutic tactics.
Treatment
Cholangiocarcinoma was originally considered a tumor with an unfavourable prognosis. Until now, surgical treatment has been the only relatively effective approach. However, even this treatment method is an option for only 35% of patients. Another 35% mostly are patients with unresectable tumors or other health conditions that make them not eligible for surgery.
For 10 years, chemotherapy based on a combination of gemcitabine and cisplatin has remained the standard first-line therapy in patients with locally advanced or metastatic cholangiocarcinoma. Attempts to use various chemotherapeutic regimens, both in monotherapy and in combinations, have been relatively successful. In order not to leave the patient without treatment, fluoropyrimidines in combination with oxaliplatin or irinotecan, are empirically prescribed as the consolidation therapy.
The treatment method, however, always depends on the localization of cholangiocarcinoma, which is divided into intrahepatic, distal (localized below the cystic bile duct), and hilar cholangiocarcinoma (Klatskin tumor) that is localized in the area of confluence of the bile ducts.
The only effective treatment for patients with Klatskin tumor is surgery, and the only way to achieve long-term survival is to provide an R0 resection (microscopically margin-negative resection). Taking into account the peculiarities of the anatomical structure of the hepatic hilum, the surgical procedure is an extremely difficult task that can be solved only by performing an extended liver resection with total caudate lobectomy with hepaticoholedochus, wide lymphadenectomy, and often resection of the portal vein, hepatic artery. The procedure is often followed by the liver transplantation.
Where can I undergo bile duct cancer treatment abroad?
Health tourism is becoming more and more popular these days, as treatment abroad often ensures a much better quality of bile duct cancer treatment.
Many European hospitals show high success rates in bile duct cancer treatment.
Experienced oncologists in European hospitals provide the most modern techniques of treatment of oncological diseases, including bile duct cancer.
The benefits of treatment abroad include:
- Up-to-date equipment for treatment and diagnosis of bile duct cancer and other liver tumors from leading brands
- The high level of expertise of oncologists and oncologic surgeons, proved by positive treatment results
- Treatment according to international protocols
- Comfortable and fully equipped hospitals
You can find more information about the hospitals specializing in liver cancer treatment on the Booking Health website.
The cost of treatment abroad
The prices in hospitals listed on the Booking Health website are relatively low. With Booking Health, you can undergo bile duct cancer treatment at an affordable price.
The cost of treatment of bile duct cancer varies, as the prices depend on the hospitals, the specifics of the disease, and the complexity of its treatment. You should also consider the cost of possible additional procedures and follow-up care. Therefore, the ultimate cost of treatment of bile duct cancer may differ from the initial price.
To make sure that the overall cost of treatment in European hospitals is suitable for you, you may contact us by leaving the request on the Booking Health website.
How can I undergo bile duct cancer treatment abroad?
It is not easy to self-organize any treatment abroad. It requires certain knowledge and expertise. Thus, it is safer, easier, and less stressful to use the services of a medical tourism agency.
As the largest and most transparent medical tourism agency in the world, Booking Health has up-to-date information about bile duct cancer treatment in the best hospitals. We will help you select the right European hospital according to your wishes.
We want to help you and take on all the troubles. You can be free of unnecessary stress, while Booking Health takes care of all organizational issues regarding the treatment. Our services aimed at undergoing bile duct cancer treatment abroad safely and successfully.
Medical tourism can be easy! All you need to do is to leave a request on the Booking Health website, and our manager will contact you shortly.
Authors:
The article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova and Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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