Good Outcomes: Survival Rates for Cholangiocarcinoma

With an increasing incidence of this deadly cancer in the U.S. and worldwide, early diagnosis and referral to a specialized center is becoming more important for CCA, which is an adenocarcinoma that arises from the biliary tract and is the second most common primary cancer of the liver. Depending on the origin of the cancer, it is classified as extrahepatic or intrahepatic. “We are one of a few centers in the country that transplants patients with intrahepatic cholangiocarcinoma, and our patients do very well after transplant. This is a transplantable cancer for us,” said Kodali, who recently attended the International CCA Meeting in Salt Lake City where she spoke to 200 or more patients, families and healthcare professionals. “Three patients with intrahepatic tumors came up to me and said they had never heard this condition is transplantable,” she said again highlighting the importance of how little is known about transplant surgery being an option in the right setting for this very aggressive and fatal cancer. “We are learning more about the disease and have better diagnostic capabilities and treatment options at this point even compared to five or 10 years ago,” Kodali said. Kodali noted that patients often lack symptoms until they have advanced disease, limiting the treatment options like surgery or transplant that can cure the disease. When symptoms are absent and nonspecific, the diagnosis of CCA is made after imaging studies are performed. When patients present with symptoms, they have jaundice, abdominal pain, decreased appetite, weight loss and night sweats.

Patients who have no prior liver issues see their primary care physician initially, and a diagnosis is made based on their clinical presentation, abnormal liver labs and then imaging. However, a proportion of patients also are diagnosed as they may already be seeing a liver specialist for liver-related issues like hepatitis B, C, or primary sclerosing cholangitis and may develop cholangiocarcinoma, she said. A good scan is extremely important in diagnosis; staging and performing a biopsy confirm the diagnosis. A more complex cancer than other cancers, treatments can be a combination of internal radiation and chemotherapy while a resection is planned in patients who can get surgery. “Then, there’s a high risk of recurrence, especially with intrahepatic cholangiocarcinoma,” Kodali said. “In other words, it’s a very aggressive and often fatal cancer. Transplant offers the best outcomes for patients here at Houston Methodist where patient selection is based on an institutional protocol.”