Advancements in cholangiocarcinoma: evolving strategies for diagnosis, treatment, and palliation over three decades.

Abstract

In recent years, significant progress has been made in the diagnosis, treatment, and palliation of cholangiocarcinoma (CC). CC accounts for 15% of all primary liver neoplasms and 3% of all gastrointestinal malignancies. Despite the significant advances in the diagnosis and treatment of CC, this tumor remains a formidable challenge, accounting for 2% of all cancer-related deaths. Chronic inflammation, genetic predisposition, and congenital biliary abnormalities are the primary risk factors for CC. CC is anatomically categorized into intrahepatic CC (ICC), perihilar, and distal types, with the latter two collectively termed extrahepatic CC (ECC). Although the incidence of ICC surpasses that of ECC, both have exhibited an upward trend over the last two decades. The advancements in diagnostic techniques, including high-resolution imaging modalities such as magnetic resonance imaging (MRI) and positron emission tomography (PET) scans, have improved the early detection and staging of CC. Molecular profiling and biomarker discovery have further enabled personalized treatment approaches. Endoscopic techniques have also evolved, providing minimally invasive options for biopsy and stent placement, which improve both diagnosis and palliative care. Treatment strategies have seen significant evolution, with surgical resection and liver transplantation being the only curative options. The refinement of surgical techniques and perioperative care has increased the success rates of these procedures. Additionally, neoadjuvant and adjuvant therapies, including chemoradiation, have shown promise in improving surgical outcomes and overall survival rates. Multidisciplinary teams (MDTs) play a crucial role in managing CC, ensuring that patients receive comprehensive care that includes surgical, medical, and supportive treatments. This team approach has led to the development of more effective treatment protocols and improved patient outcomes. Palliative care has also advanced, with new chemotherapeutic agents and targeted therapies providing better management of symptoms and prolongation of life. Innovations in interventional radiology, such as radiofrequency ablation and transcatheter arterial chemoembolization (TACE), offer additional palliative options that can significantly enhance quality of life. This review article outlines the progress made in diagnosing and treating individuals with CC over the last 30 years, highlighting the critical role of technological advancements and multidisciplinary care in improving patient outcomes.