Kolanjioseluler Karsinoma Tanı ve Tedavi Yöntemleri
Özet
Kolanjiokarsinoma (safra kanalı kanseri), intrahepatik, perihiler veya distal biliyer ağaçtaki epitel hücrelerinden kaynaklanan bir malignitedir. Hastalar genellikle ağrısız sarılık, sağ üst kadran ağrısı ve kilo kaybı gibi semptomlarla başvururken, intrahepatik yerleşimlerde sarılık daha nadir görülür. Tanı ve evrelemede Amerikan Ortak Kanser Komitesi (AJCC) 8. baskı kılavuzuna göre perihiler, distal ve intrahepatik tümörler farklı T ve N kriterleri ile sınıflandırılır. Primer sklerozan kolanjit (PSC), fibropolikistik karaciğer hastalıkları, kronik hepatit B/C enfeksiyonları, siroz ve parazit enfeksiyonları en önemli risk faktörleri arasındadır. Histolojik olarak tümörlerin yüzde 90'ından fazlası adenokarsinomdur. Teşhiste serum aminotransferazlar, alkalin fosfataz, bilirubin, CA 19-9 ve CEA gibi laboratuvar tetkiklerinin yanı sıra ultrason, BT, MRI/MRCP ve ERCP gibi radyografik yöntemler kullanılır. Tedavi yönetiminde stent yerleştirme ve fotodinamik terapi gibi palyatif yöntemler, adjuvan/preoperatif radyoterapi, gemsitabin-sisplatin tabanlı kemoterapi ve FGFR2/IDH1 mutasyonlarını hedefleyen tedaviler uygulanmaktadır. Tam cerrahi rezeksiyon (intrahepatik/Klatskin için karaciğer rezeksiyonu, distal için Whipple prosedürü) iyileşme şansı sunan tek küratif seçenektir; ancak hastaların yalnızca yüzde 10'u erken evrede teşhis edilerek cerrahiye aday olabilmektedir.
Cholangiocarcinoma (bile duct cancer) is a malignancy originating from the epithelial cells of the intrahepatic, perihilar, or distal biliary tree. Patients commonly present with painless jaundice, right upper quadrant abdominal pain, and weight loss, though jaundice is less frequent in intrahepatic cases. Diagnosis and staging are categorized into perihilar, distal, and intrahepatic tumors according to the AJCC 8th edition, utilizing distinct T and N criteria. Primary sclerosing cholangitis (PSC), fibropolycystic liver disease, chronic hepatitis B/C infections, cirrhosis, and parasitic infections constitute major risk factors. Histologically, over 90 percent of cases are adenocarcinomas. Diagnostic evaluation involves laboratory panels including serum aminotransferases, alkaline phosphatase, bilirubin, CA 19-9, and CEA, along with imaging modalities like ultrasound, CT, MRI/MRCP, and ERCP. Therapeutic management includes palliative measures such as stent placement and photodynamic therapy, adjuvant or preoperative radiotherapy, gemcitabine-cisplatin-based chemotherapy, and targeted therapies focusing on FGFR2 or IDH1 mutations. Complete surgical resection (liver resection for intrahepatic/Klatskin tumors and the Whipple procedure for distal tumors) remains the only curative treatment; however, only about 10 percent of patients present with early-stage disease eligible for surgery.
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