Micrograph of an intrahepatic, i.e. in the liver,<unk>  (right of image); benign hepatocytes are seen (left of image). Histologically, this is a<unk>  as (1) atypical bile duct-like cells (left of image) extend from the tumor in an interlobular septum (the normal anatomical location of bile ducts), and (2) the tumor has the abundant desmoplastic stroma often seen in<unk> s. A portal triad (upper-left of image) has a histologically normal bile duct. H&E stain. Blood tests There are no specific blood tests that can diagnose<unk>  by themselves. Serum levels of carcinoembryonic antigen (CEA) and CA19-9 are often elevated, but are not sensitive or specific enough to be used as a general screening tool. However, they may be useful in conjunction with imaging methods in supporting a suspected diagnosis of<unk> . Abdominal imaging CT scan showing<unk>  Ultrasound of the liver and biliary tree is often used as the initial imaging modality in people with suspected obstructive jaundice. Ultrasound can identify obstruction and ductal dilatation and, in some cases, may be sufficient to diagnose<unk> . Computed tomography (CT) scanning may also play an important role in the diagnosis of<unk> . Imaging of the biliary tree ERCP image of<unk> , showing common bile duct stricture and dilation of the proximal common bile duct While abdominal imaging can be useful in the diagnosis of<unk> , direct imaging of the bile ducts is often necessary. Endoscopic retrograde cholangiopancreatography (ERCP), an endoscopic procedure performed by a gastroenterologist or specially trained surgeon, has been widely used for this purpose. Although ERCP is an invasive procedure with attendant risks, its advantages include the ability to obtain biopsies and to place stents or perform other interventions to relieve biliary obstruction. Endoscopic ultrasound can also be performed at the time of ERCP and may increase the accuracy of the biopsy and yield information on lymph node invasion and operability. As an alternative to ERCP, percutaneous transhepatic cholangiography (PTC) may be utilized. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive alternative to ERCP. Some authors have suggested that MRCP should supplant ERCP in the diagnosis of biliary cancers, as it may more accurately define the tumor and avoids the risks of ERCP. Surgery Photograph of<unk>  in human liver. Surgical exploration may be necessary to obtain a suitable biopsy and to accurately stage a person with<unk> . Laparoscopy can be used for staging purposes and may avoid the need for a more invasive surgical procedure, such as laparotomy, in some people. Pathology Histologically,<unk> s are classically well to moderately differentiated adenocarcinomas. Immunohistochemistry is useful in the diagnosis and may be used to help differentiate a<unk>  from hepatocellular carcinoma and metastasis of other gastrointestinal tumors. Cytological scrapings are often nondiagnostic, as these tumors typically have a desmoplastic stroma and, therefore, do not release diagnostic tumor cells with scrapings. Staging Although there are at least three staging systems for<unk>  (e.g. those of Bismuth, Blumgart, and the American Joint Committee on Cancer), none have been shown to be useful in predicting survival. The most important staging issue is whether the tumor can be surgically removed, or whether it is too advanced for surgical treatment to be successful. Often, this determination can only be made at the time of surgery. General guidelines for operability include: * Absence of lymph node or liver metastases * Absence of involvement of the portal vein * Absence of direct invasion of adjacent organs * Absence of widespread metastatic disease
Cholangiocarcinoma
Hepatoid tumor
Cholangiosarcoma
Periampullary cancer
Pancreatoblastoma
Hepatocellular carcinoma
Echinococcosis
Hepatoblastoma