Biliary tract cancers: Current concepts and controversies Journal Article
| Authors: | Leonard, G. D.; O'Reilly, E. M. |
| Article Title: | Biliary tract cancers: Current concepts and controversies |
| Abstract: | Biliary tract cancer, which consists of gall bladder cancer and cholangio-carcinoma, presents many challenges to practising physicians. It is a relatively rare cancer that often causes a diagnostic dilemma, as its presentation may be similar to that of non-malignant conditions. In many cases, histological or cytological confirmation of a cancer diagnosis is not possible preoperatively. The management of this disease is also complex due to a morbid patient population and limited data on the optimal therapeutic approach. Surgery remains the mainstay of treatment, although the extent of resection required is still debated. The role of adjuvant therapy is also controversial, but a combined modality approach appears to be beneficial in patients with a high risk of recurrence, such as those with node positive tumors or positive resection margins. When surgery is not possible, the prognosis of patients with biliary tract cancer is very poor. In unresectable patients, the combination of chemotherapy and radiotherapy can result in a prolonged survival for some patients. In the palliative setting, biliary stenting and other supportive measures can alleviate symptoms and improve survival. Gemcitabine-based combination chemotherapy may also provide successful palliation and has achieved response rates of ∼ 30% and a median survival of > 15 months in one study. Ultimately, treatment decisions should be individualised and participation in clinical trials is encouraged. Further progress in the management of biliary tract cancer is anticipated using biological therapies and continued research is essential to discover the optimal treatment for this challenging disease. © 2005 Ashley Publications Ltd. |
| Keywords: | cancer survival; surgical technique; clinical feature; clinical trial; drug tolerability; histopathology; pathogenesis; review; cancer recurrence; cisplatin; doxorubicin; erlotinib; fluorouracil; cancer combination chemotherapy; multimodality cancer therapy; treatment planning; antineoplastic agents; capecitabine; gemcitabine; paclitaxel; cancer adjuvant therapy; chemotherapy; cancer staging; neoplasm staging; preoperative evaluation; cancer palliative therapy; medical decision making; imatinib; alpha2b interferon; carboplatin; radiation; blood toxicity; morbidity; ca 19-9 antigen; carcinoembryonic antigen; estrogen; cancer pain; cancer research; high risk patient; docetaxel; irinotecan; survival time; folinic acid; data analysis; medical practice; surgery; physician; stent; epirubicin; mitomycin c; bile duct carcinoma; bile duct neoplasms; cholangiocarcinoma; symptomatology; diagnostic test; biological therapy; cholecystectomy; gallbladder neoplasms; mitomycin; oxaliplatin; photodynamic therapy; gallbladder cancer; exatecan; biliary tract cancer; biliary tract neoplasms; cytopathology; clinical trials; analgesic agent; individualization; raltitrexed; rebeccamycin |
| Journal Title: | Expert Opinion on Pharmacotherapy |
| Volume: | 6 |
| Issue: | 2 |
| ISSN: | 1465-6566 |
| Publisher: | Informa Healthcare |
| Date Published: | 2005-02-01 |
| Start Page: | 211 |
| End Page: | 223 |
| Language: | English |
| DOI: | 10.1517/14656566.6.2.211 |
| PUBMED: | 15757418 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 15" - "Export Date: 24 October 2012" - "CODEN: EOPHF" - "Source: Scopus" |
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