Hepato-Pancreatico-
Biliary Cancer


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Hepato-Pancreatico-Biliary Cancer

Hepato-pancreatico-biliary tract cancer are unique among themselves, though being linked to each other in-terms of function and anatomical position their causative factor differ and  they have poor prognosis as compared to other gastro-intestinal malignancy like colon and rectum. Management of liver tumors is challenging as they are associated with chronic liver disease and liver failure caused by a common causative factor. Biliary tract tumors often present with jaundice are detected early but due to complex anatomical location operability is an issue, an exception to this is gall bladder cancer which usually present late. Pancreatic cancer has dismal prognosis even after complete excision the overall five year survival is 29%

  • Causes
  • Diagnosis
  • Treatment

Causes

Liver tumors also known as hepatocellular carcinoma (HCC) are caused by chronic infection with hepatitis C (HCV) and hepatitis B virus (HBV). HCV and HBV infection also leads to chronic liver disease and cirrhosis of liver. Other common causes associated with HCC is NASH (non-alcoholic steatohepatitis) seen in overweight and obese individual, and chronic alcohol ingestion leading to liver cirrhosis. Biliary tract cancer is caused by infestation with flukes Opisthorchis viverrini and Clonorchis sinensis and also biliary tract stone. Gall bladder cancer are most commonly caused by long standing gall stone. Pancreatic cancer in contrast is more commonly linked with genetic factor, although alcohol and smoking is found to be risk factor, no conclusive evidence found for it.

Diagnosis

Pain in upper abdomen or jaundice, ultrasound is the first investigation of choice, it is followed by Contrast enhanced CT scan of abdomen which gives detailed extent of the tumor. Biliary tract cancer are evaluated by Magnetic Resonance Cholangio-pancreatico graphy (MRCP) which gives detailed images of entire biliary tree. Serum tumor markers specifically for liver tumors is Alpha Feto-protein (AFP) which is commonly elevated in HCC. CA 19-9 and CEA are commonly elevated in pancreatic and biliary tract tumors respectively. Surgical treatment for pancreatic and biliary tract tumors donot require pre-op biopsy. If surgery is not contemplated biopsy can be done with CT scan or ultrasound guided.

Treatment

Surgical management is the cornerstone for hepato-pancreatico-biliary tract tumors. Before surgical interventions in liver tumors it is necessary to assess the future residual liver function to sustain life, as liver tumors are associated with cirrhotic liver (a condition where major part of liver has lost its function). Biliary tract and pancreatic tumors are associated with jaundice and that may require pre-op drainage to correct coagulopathy. Overall survival even after complete resection is dismal in these tumors.

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