Biliary Tract Cancer

Gallbladder cancer (GBC) is an aggressive disease with an overall poorer prognosis. The presentation of early GBC is usually non-specific and hence it is detected late or incidentally following cholecystectomy. R0 surgical resection is the only curative treatment for GBC in the early stage. Adjuvant therapy is indicated for patients with pathological stage II/stage III disease. The role of neoadjuvant therapy to downstage the disease in the locally advanced stage is emerging. Appropriate non-surgical palliative intervention is required in advanced/metastatic disease. Cholangiocarcinoma (CCA) refers to the tumors arising from the bile duct system. They are slow-growing tumors with nonspecific symptoms and poor prognosis. Hilar CCA is the most common subtype. Jaundice is the most common complaint, seen in about 70–90% of patients, followed by pruritus and abdominal pain. In resectable cases, it may be reasonable to proceed to surgery without tissue diagnosis. Complete surgical resection is the only possible treatment with curative intent. Adjuvant treatment in the form of chemoradiation improves long-term outcomes especially in margin-positive/node-positive tumors, though there is a lack of convincing data due to the rarity of the disease. Gemcitabine and cisplatin-based chemotherapy is the preferred regimen in advanced cholangiocarcinoma.