Diagnosis and Evaluation of Cholangiocarcinoma

Cholangiocarcinoma is a malignancy of the biliary tree with a poor 5-year survival. Because of the aggressive nature of the cancer and its tendency to present at advanced stages, making an early and accurate diagnosis is paramount to optimizing outcomes. Cholangiocarcinomas are classified based on their anatomic location as intrahepatic, perihilar, or distal. These types of cholangiocarcinomas are distinct in their presentations and warrant different approaches to diagnosis and management. Diagnosis can be made by integrating the clinical presentation, tumor markers, radiological appearance and histology. Physicians often face several challenges during the workup and diagnosis of cholangiocarcinoma. While tumor markers can lack of sensitivity and specificity, radiological imaging sometimes fails to distinguish cholangiocarcinoma from hepatocellular carcinoma or non-malignant diseases. Another challenge is the difficulty of acquiring a sufficient tissue sample for diagnosis. The aim of this chapter is to review the clinical and laboratory findings of cholangiocarcinoma in addition to different imaging modalities and tissue acquisition methods.