Last Modified: September 17, 2006
Dear OncoLink "Ask The Experts,"
What treatments are used for Klatskin tumors?
Weijing Sun, MD, Assistant Professor of Medicine at the University of Pennsylvania, the Director of Upper GI and Pancreatic-biliary-hepatic Cancer Group and the Associate Director of the GI Cancer Program, responds:
Klatskin tumors are a type of cholangiocarcinoma. This is a tumor of the bile duct system. Dr. Klatskin first described this tumor in 1965. It is located at the bifurcation of the common bile duct, or in other words, the site where two ducts draining from the liver join to make one duct, which then drains into the bowel.
The cause of cholangiocarcinoma is unknown, but rates are higher in people with ulcerative colitis and Crohn's disease. Given that the tumor blocks drainage from the bile duct, people develop symptoms related to the obstruction. These include jaundice (yellowing of the skin), clay-colored stools (because bile normally darkens the stool, but in this case is not draining into the bowel), bilirubinuria (dark urine), pruritus (itchy skin), weight loss, and abdominal pain. Jaundice is the most common symptom with cholangiocarcinomas, and is often the presenting symptom. Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that is used to take a biopsy of a suspicious bile duct mass, and it can allow placement of a stent to open the duct and relieve jaundice.
As they are located close to the liver, Klatskin tumors can involve the liver and one or both ducts. If the tumor only involves one side of the liver and/or one side of the bile duct, it may be possible to surgically remove it. If surgery is not possible, radiation therapy is used with or without low-dose chemotherapy; the latter makes the tissue more sensitive to the radiation. The chemotherapy medications that are most often used are fluorouracil and gemcitabine. Cisplatin has been given with gemcitabine for patients not receiving radiation therapy.
Photodynamic therapy is being studied in clinical trials as a treatment for cholangiocarcinomas and has shown promising results for inoperable tumors.