Gastroenterology Education and CPD for trainees and specialists

1. A 50 year old man with PSC presented with obstructive jaundice. A CT scan raised the possibility of cholangiocarcinoma. The following are true except:

1. ERCP and brush cytology usually yield the diagnosis
2. PSC is the commonest predisposing factor for cholangiocarcinoma in the western world.
3. The risk of developing cholangiocarcinoma is not associated with the duration of PSC.
4. Cholangiocarcinoma is often associated with intermittent rather than steadily progressive jaundice.
5. PET may be used is in screening patients with PSC for the presence of cholangiocarcinoma.

Explanation :Tissue diagnosis of cholangiocarcinoma is difficult because it is highly desmoplastic tumour composed of a few malignant cholangiocytes within excessive fibrous tissue. Thus cytology is positive in only 1/3rd of cases.

2. A 70 year old man presents with painless obstructive jaundice. A CT scan is suspicious for tumour involving common hepatic duct bifurcation (Klatskin tumour). The following statements are true except:

1. A raised Ca19-9 is diagnostic
2. Distant metastases are distinctly uncommon in cholangiocarcinoma.
3. Majority of cholangiocarcinoma are adenocarcinoma
4. Laparoscopy should be standard before resection
5. Biliary stents are often placed prior to surgery

Explanation :A raised Ca19-9 is suggestive but not diagnostic. Laparoscopy will identify 25-30% of patients as unresectable who were thought to be operable before laparoscopy. Therefore laparoscopy should be standard before operation. Many surgeons proceed directly to laparotomy without preoperative biliary drainage. On the other hand, there is often uncertainty as to resectability as well as the timetable of surgical evaluation and operative management in patients presenting with jaundice. As a practical issue, stents are often placed to alleviate jaundice while these issues are being settled.

Gastroenterology training and education

MCQ On Cholangiocarcinoma

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