Intrahepatic Cholangiocarcinoma: Early Symptoms and Chances of Cure

Intrahepatic cholangiocarcinoma is a prevalent condition in hepatobiliary surgery, with an elusive etiology. Known contributors to its development encompass chronic cholangitis, parasitic infections, congenital choledochal cysts, genetic predispositions, cholelithiasis, and biliary cirrhosis. Early detection and surgical intervention may offer a cure for a limited number of patients. This article delves into the early symptoms and potential for cure in intrahepatic cholangiocarcinoma.

I. Early Symptoms of Intrahepatic Cholangiocarcinoma

(1) Symptoms:

① Jaundice: The most prevalent symptom, affecting approximately 36.5% of patients. It stems from biliary obstruction and progresses gradually, its severity correlating with the location and extent of obstruction. Extrahepatic obstruction leads to deeper jaundice, while intrahepatic obstruction results in a milder form. Complete obstruction intensifies jaundice, while incomplete obstruction attenuates it. Inflammation, spasms, or tumor detachment/displacement can cause fluctuations. Mid-to-lower segment cholangiocarcinoma often presents as painless biliary obstructive jaundice, accompanied by dark yellow or tea-colored urine and pale or clay-colored stools.

② Abdominal Pain: Can manifest as mild upper abdominal discomfort post-meal, dull sternal discomfort, backache, or right upper abdominal cramps. These are indicative of neural invasion and may precede or follow jaundice.

③ Fever: Largely attributed to inflammation within the obstructed bile duct and occurs infrequently.

(2) Signs:

① Hepatomegaly: Observed in over 80% of patients, primarily due to intrahepatic bile accumulation.

② Gallbladder Enlargement: Palpable in patients with cancer located below the confluence of the three ducts.

③ Ascites: May develop in later stages due to peritoneal or portal vein invasion, leading to portal hypertension.

II. Is Early Intrahepatic Cholangiocarcinoma Curable?

While aggressive radical surgical treatment can yield a curative effect for a minute fraction of patients with early-stage cholangiocarcinoma, the malignancy is often high, and many patients present with symptoms indicative of middle or later stages. Additionally, postoperative complications like pancreatic and intestinal fistulas, particularly in lower segment cholangiocarcinoma patients undergoing pancreatoduodenectomy, can lead to infectious shock and even death.