Cholangiocarcinoma Described

John L. Marshall, MD: Hello, and welcome to this OncLive® Peer Exchange®, “Clinical Updates on the Treatment of Advanced Cholangiocarcinoma.” I’m Dr John Marshall from The Ruesch Center for the Cure of Gastrointestinal Cancers at Georgetown University in Washington, DC. I am excited because I’m going to learn a lot from these smart people who have joined us on our broadcast. Let’s start with Dr Kate Kelley from the Helen Diller Family Comprehensive Cancer Center in San Francisco, California. Katie, good morning. How are you doing?
 

R. Kate Kelley, MD: Good morning. Thank you for having me.

John L. Marshall, MD: We’re glad to have you. Next, Dr Sameek Roychowdhury from The James Cancer Hospital and Solove Research Institute in Columbus, Ohio. Sameek, welcome.

Sameek Roychowdhury, MD, PhD: Thank you.

John L. Marshall, MD: Last, but not least, Dr Milind Javle from The University of Texas MD Anderson Cancer Center in Houston, Texas. Milind, welcome.

Milind Javle, MD: Thank you, John.

John L. Marshall, MD: We’re going to dive in deep on what’s going on in cholangiocarcinoma. There is quite a bit of new data, both on the molecular and management side and on quality of life. There were some interesting new updates, many of whose authors are joining us from the 2021 ASCO GI [American Society of Clinical Oncology Gastrointestinal Cancers Symposium]. It was supposed to be in San Francisco, but we all did it from Zoom.

Let’s dive right in. Sameek, I’m going to let you kick us off. Talk about cholangiocarcinoma. When I was trained, this really wasn’t a diagnosis, but it’s become a hot item and has some subtleties to it.
 

Sameek Roychowdhury, MD, PhD: I did not see a lot of cholangiocarcinoma in my fellowship training. I’ve come to see a lot of it now, and cholangiocarcinoma is cancer affecting the liver. I think about the liver as 2 types of cells. The cells are sort of the factories and cities of the liver, the hepatocytes. These cells are the conduits of the liver—the arteries, veins, and the bile ducts. Each liver cell type can be affected by cancer. Cholangiocarcinoma is a bile duct cancer, so it can be seen anywhere—in a small or large duct in the liver, in a duct that’s just outside the liver. That’s often how we think about cholangiocarcinoma. Is it intrahepatic, inside the liver; perihilar, just outside the liver; or in a distal duct that exits the liver. That’s how we and our surgical colleagues think about the anatomy that affects the resectability of cholangiocarcinoma. It also tells us how patients present. With a tumor in a bile duct, people can have pain in their right upper quadrant, nausea, cholangitis, infection, as well as fever and weight loss. Those are the typical presenting symptoms. We’ve seen an increase in diagnoses of cholangiocarcinoma. Around 10,000 patients a year probably have bile duct cancer in the United States. It’s hard to estimate how many people get this cancer worldwide. I’d be interested to see what our colleagues have to say about the incidence and prevalence of this disease and how it can be confused with other diagnoses.

John L. Marshall, MD: I like your factory analogy. I always use trees because it looks like a tree to me: The common bile ducts are the trunk of the tree, the gallbladder is a little knot off the side of the tree, the wooden parts of the tree are the intrahepatic cholangio, and the leaves of the tree are the liver. We all have our analogies we use to teach our patients, as well as our fellows and others around us, about this disease.

Transcript Edited for Clarity