Klatskin tumor

Klatskin tumor in the ERC . The patient lies diagonally on his stomach so that the left side of the image corresponds to the left side of the patient. A wire is placed in each of the left and right biliary system, which is required for the subsequent insertion of stents for biliary drainage. Both parts on the right and left were injected with contrast agent one after the other via a probe. You can clearly see the lack of contrast in the area of the confluence, where the wires run parallel again.

Classification according to ICD-10
C24.0	Malignant neoplasm of extrahepatic bile duct
ICD-10 online (WHO version 2019)

The Klatskin tumor is a special form of the bile duct carcinoma (also cholangiocellular carcinoma or cholangiocarcinoma ) and a malignant tumor of the biliary duct . One or more bile duct branches are blocked. Bile congestion with obstructive jaundice and fat digestion disorders are the consequences. There are numerous risk factors that favor the development of the tumor, such as previous gallstones or chronic inflammatory diseases of the large biliary tract. A Klatskin tumor affects the liver early , which is why it is inoperable in most cases. The tumor gives rise to some symptoms, but they only appear in the advanced stages of the disease. It is mainly jaundice with itching and fatty stools. Other symptoms include fatigue and weight loss .

The tumor is difficult to treat because it is centrally located in the porta hepatica and metastasizes quickly. If it is recognized in time, it can be removed by radical surgery. However, many patients already have metastases at the time of diagnosis, which means that healing is no longer possible. Then there are only life-extending measures in the room, such as chemotherapy or radiation therapy . Various studies are currently underway to find out how the tumor can be better treated. The photodynamic therapy aims to specifically destroy tumor cells. However, it is unclear what benefit this method has. Patients under 60 years of age have the worst prognosis because the tumor grows rapidly at a young age and the maximum survival time after diagnosis is one to two years.

The tumor is named after the US gastroenterologist Gerald Klatskin (1910–1986).

Classification and location

The Klatskin tumor has two types, the diffuse infiltrating and the polypoid intraluminal type. Both can merge into one another. Some tumors already show lymph node metastases at diagnosis .

The tumor is located at the fork of the hepatic nerve and corresponds to types II to IV of the bismuth classification:

Type I: Carcinoma affects the common hepatic duct without the hepatic fork
Type II: Carcinoma also involves the fork of the hepatic nerve
Type III: The tumor extends on one side (type IIIa right, type IIIb left) to the segmental branches
Type IV: The secondary confluences on the right and left are affected. A curative resection is difficult or impossible.

Symptoms

Main symptom: jaundice ( jaundice )

In the advanced stage, jaundice, epigastric discomfort and fatigue occur. Indigestion and weight loss follow later. Those affected often suffer from a lack of appetite .

Diagnosis

Sick people have a changed blood count. A computed tomography , magnetic resonance tomography or endoscopic retrograde cholangiography helps with the diagnosis .

therapy

ERC: Insertion of one stent each into the left and right biliary system. On the right, the previously given contrast agent has already drained off well and a clear aerospace can be seen .

Only a complete removal of the tumor can lead to healing. This is only possible in less than 50% of the cases. In no longer operable cases, stents are used to secure the bile outflow .

Causes and Risk Factors

A significant risk factor for the development of the tumor is previous gallstone disease . The target group should do follow-up care so that such a tumor can be quickly identified and operated on.

forecast

The prognosis of the tumor is poor; the published 9-year survival rates are only around 20%.

literature

B. Juntermanns, CD Fingas, GC Sotiropoulos, D. Jaradat, A. Dechêne, H. Reis, S. Kasper, A. Paul, GM Kaiser: Klatskin tumor: long-term survival after surgery. In: The surgeon . 87, 2016, pp. 514-519. (Abstract)

Web links

Individual evidence

↑ Alphabetical index to the ICD-10-WHO version 2019, volume 3. German Institute for Medical Documentation and Information (DIMDI), Cologne, 2019, p. 448
↑ Klatskin tumor. In: medlexi.de. September 5, 2019, accessed February 28, 2020 .
↑ Witzigmann H et al :: Therapy concepts and results in Klatskin tumors. In: Dtsch Arztebl 2008; 105 (9): 156-61; DOI: 10.3238 / arztebl.2008.0156. February 29, 2008, accessed January 20, 2020 .

[1] Alphabetical index to the ICD-10-WHO version 2019, volume 3. German Institute for Medical Documentation and Information (DIMDI), Cologne, 2019, p. 448

[:0-2] Klatskin tumor. In: medlexi.de. September 5, 2019, accessed February 28, 2020 .

[3] Witzigmann H et al :: Therapy concepts and results in Klatskin tumors. In: Dtsch Arztebl 2008; 105 (9): 156-61; DOI: 10.3238 / arztebl.2008.0156. February 29, 2008, accessed January 20, 2020 .