Das cholangiozellul?re Karzinom aus der Sicht des Internisten und des Chirurgen

Cholangiocellular carcinomas (CCC) are rare tumors with an incidence of 2–4/100,000 per year. They are a heterogeneous group of neoplasias that includes the perihilar or Klatskin tumors (at 60%, the most common of the CCC), the intrahepatic (peripheral) CCC, extrahepatic bile duct cancer, gallbladder cancer, and cancer of the ampulla of Vater. At the time of diagnosis, only 30% of patients are eligible for surgery, which offers the only chance for cure. Due to high recurrence rates, liver transplantation is restricted to select patients with small but nonresectable tumors. Patients with advanced nonresectable carcinoma have a dismal prognosis, with an overall survival of only 6–8 months. In inoperable patients, prevention or treatment of cholestasis is the main objective. This can be achieved endoscopically, percutaneously, or by surgical biliodigestive anastomosis. Palliative chemotherapy results in tumor stabilization rates of up to 60%. The most frequently used agents are fluoropyrimidines and gemcitabine in combination with a platin derivative. When different treatment modalities are combined, significant survival can be achieved in some patients.