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Baris 1: ~~{{sedang ditulis}}~~ {{Infobox medical condition (new) \| name = Kolangiokarsinoma Baris 25 ⟶ 24: '''Kolangiokarsinoma''' atau dikenal sebagai '''kanker saluran empedu''' adalah jenis kanker yang terbentuk di saluran empedu.<ref>{{Cite web\|date=2011-02-02\|title=cholangiocarcinoma\|url=https://www.cancer.gov/publications/dictionaries/cancer-terms/def/cholangiocarcinoma\|website=cancer\|language=en\|access-date=2022-02-10}}</ref> Beberapa gejala yang timbul pada pengidap kolangiokarsinoma antara lain sakit perut, kulit kekuningan, penurunan berat badan, rasa gatal, dan demam.<ref name=":0">{{Cite web\|date=2021-10-08\|title=Bile Duct Cancer (Cholangiocarcinoma) Treatment (PDQ®)–Health Professional Version - National Cancer Institute\|url=https://www.cancer.gov/types/liver/hp/bile-duct-treatment-pdq\|website=cancer\|language=en\|access-date=2022-02-10}}</ref> Perubahan warna tinja menjadi lebih terang atau urin menjadi lebih gelap juga dapat terjadi.<ref name=":1">{{Cite web\|date=2021-08-20\|title=Bile Duct Cancer (Cholangiocarcinoma) Treatment (PDQ®)–Patient Version - National Cancer Institute\|url=https://www.cancer.gov/types/liver/patient/bile-duct-treatment-pdq\|website=www.cancer.gov\|language=en\|access-date=2022-02-10}}</ref> Kanker saluran empedu lainnya yaitu kanker [[Kantong empedu\|kandung empedu]] dan kanker ampula vater.<ref>{{Cite journal\|last=Benavides\|first=M.\|last2=Antón\|first2=A.\|last3=Gallego\|first3=J.\|last4=Gómez\|first4=M. A.\|last5=Jiménez-Gordo\|first5=A.\|last6=La Casta\|first6=A.\|last7=Laquente\|first7=B.\|last8=Macarulla\|first8=T.\|last9=Rodríguez-Mowbray\|first9=J. R.\|date=2015-12-01\|title=Biliary tract cancers: SEOM clinical guidelines\|url=https://doi.org/10.1007/s12094-015-1436-2\|journal=Clinical and Translational Oncology\|language=en\|volume=17\|issue=12\|pages=982–987\|doi=10.1007/s12094-015-1436-2\|issn=1699-3055\|pmc=PMC4689747\|pmid=26607930}}</ref> Faktor risiko untuk kolangiokarsinoma antara lain adalah ''primary sclerosing cholangitis'' (penyakit [[radang]] saluran empedu), [[kolitis ulseratif]], sirosis, [[hepatitis C]], [[hepatitis B]], infeksi cacing hati tertentu, dan beberapa malformasi hati kongenital.<ref name=":0" /><ref name=":2">{{Cite journal\|last=Razumilava\|first=Nataliya\|last2=Gores\|first2=Gregory J.\|date=2014-06-21\|title=Cholangiocarcinoma\|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61903-0/abstract\|journal=The Lancet\|language=English\|volume=383\|issue=9935\|pages=2168–2179\|doi=10.1016/S0140-6736(13)61903-0\|issn=0140-6736\|pmc=PMC4069226\|pmid=24581682}}</ref><ref>{{Cite journal\|last=Steele\|first=Jennifer A.\|last2=Richter\|first2=Carsten H.\|last3=Echaubard\|first3=Pierre\|last4=Saenna\|first4=Parichat\|last5=Stout\|first5=Virginia\|last6=Sithithaworn\|first6=Paiboon\|last7=Wilcox\|first7=Bruce A.\|date=2018-05-17\|title=Thinking beyond Opisthorchis viverrini for risk of cholangiocarcinoma in the lower Mekong region: a systematic review and meta-analysis\|url=https://doi.org/10.1186/s40249-018-0434-3\|journal=Infectious Diseases of Poverty\|volume=7\|issue=1\|pages=44\|doi=10.1186/s40249-018-0434-3\|issn=2049-9957\|pmc=PMC5956617\|pmid=29769113}}</ref> Namun, kebanyakan orang tidak memiliki faktor risiko yang dapat diidentifikasi. Diagnosis dicurigai berdasarkan kombinasi tes darah, [[pencitraan medis]], [[endoskopi]], dan terkadang melalui tindakan bedah. Untuk mengonfirmasi penyakit ini dilakukan pemeriksaan sel tumor menggunakan mikroskop.<ref name=":1" /> Kolangiokarsinoma biasanya merupakan adenokarsinoma (kanker yang membentuk kelenjar atau mengeluarkan musin).<ref name=":2" /> Setelah didiagnosis, kolangiokarsinoma biasanya tidak dapat disembuhkan. Oleh karena itu, deteksi dini sangat diperlukan.<ref name=":0" /><ref>{{Cite journal\|last=Zhang\|first=Tan\|last2=Zhang\|first2=Sina\|last3=Jin\|first3=Chen\|last4=Lin\|first4=Zixia\|last5=Deng\|first5=Tuo\|last6=Xie\|first6=Xiaozai\|last7=Deng\|first7=Liming\|last8=Li\|first8=Xueyan\|last9=Ma\|first9=Jun\|date=2021-11-23\|title=A Predictive Model Based on the Gut Microbiota Improves the Diagnostic Effect in Patients With Cholangiocarcinoma\|url=https://www.frontiersin.org/articles/10.3389/fcimb.2021.751795/full\|journal=Frontiers in Cellular and Infection Microbiology\|volume=11\|pages=751795\|doi=10.3389/fcimb.2021.751795\|issn=2235-2988\|pmc=PMC8650695\|pmid=34888258}}</ref>Dalam kasus ini, [[perawatan paliatif]] yang dapat dilakukan antara lain adalah tindakan bedah, [[kemoterapi]], [[terapi radiasi]], dan prosedur pemasangan [[stent]].<ref name=":0" /> Pada sekitar sepertiga kasus yang melibatkan saluran empedu dan lebih jarang dengan lokasi lain, [[tumor]] dapat diangkat sepenuhnya melalui tindakan pembedahan yang memberikan kesempatan untuk sembuh.<ref name=":0" /> Bahkan ketika operasi pengangkatan berhasil, kemoterapi dan terapi radiasi umumnya akan tetap direkomendasikan sebagai terapi tambahan.<ref name=":0" />Dalam kasus tertentu, tindakan operasi termasuk transplantasi [[hati]] dapat dilakukan.<ref name=":2" /> Namun, ketika operasi berhasil, kelangsungan hidup 5 tahun biasanya kurang dari 50%.<ref name=":3">{{Cite journal\|last=Bridgewater\|first=John A.\|last2=Goodman\|first2=Karyn A.\|last3=Kalyan\|first3=Aparna\|last4=Mulcahy\|first4=Mary F.\|date=2016-05-01\|title=Biliary Tract Cancer: Epidemiology, Radiotherapy, and Molecular Profiling\|url=https://ascopubs.org/doi/10.1200/EDBK_160831\|journal=American Society of Clinical Oncology Educational Book\|issue=36\|pages=e194–e203\|doi=10.1200/EDBK_160831\|issn=1548-8748}}</ref> Kolangiokarsinoma jarang terjadi di negara Barat, dengan perkiraan kejadian 0,5-2 dari 100.000 orang per tahun.<ref name=":0" /><ref name=":3" />Kolangiokarsinoma lebih banyak diidap oleh masyarakat di [[Asia Tenggara]] di mana banyak terjadi kasus infeksi oleh [[cacing hati]].<ref name=":4">{{Cite book\|last=Bosman\|first=Frank T.\|date=2014\|url=https://publications.iarc.fr/_publications/media/download/5839/bc44643f904185d5c8eddb933480b5bc18b21dba.pdf\|title=World Cancer Report 2014\|location=Lyon, France\|publisher=International Agency for Research on Cancer WHO\|isbn=978-92-832-0429-9\|pages=403-12\|others=Bernard W. Stewart, Christopher P. Wild\|oclc=903962851\|url-status=live}}</ref> Di [[Thailand]], tingkat kejadian kolangiokarsinoma adalah 60 dari 100.000 orang per tahun.<ref name=":4" />Kanker ini biasanya terjadi pada orang berusia 70-an. Namun, pada orang yang mengidap penyakit radang saluran empedu (''primary sclerosing cholangitis''), peluang kemungkinan munculnya kanker ini terjadi lebih awal yaitu pada usia 40-an. Tingkat kejadian kolangiokarsinoma di negara Barat telah mengalami peningkatan. == Tanda dan gejala == Baris 35 ⟶ 34: Indikasi paling umum yang ditemukan pada penderita kolangiokarsinoma adalah abnormalitas pada hasil tes fungsi hati, [[penyakit kuning]] (mata dan kulit menguning terjadi ketika [[saluran empedu]] tersumbat oleh [[tumor]]), sakit perut (30-50%), gatal-gatal (66%), penurunan berat badan ( 30–50%), [[demam]] (hingga 20%), dan perubahan warna [[tinja]] atau [[Urine\|urin]].<ref>{{Cite journal\|last=Llano\|first=Rodrigo Castaño\|date=2011\|title=Hilar Cholangiocarcinoma (Klatskin tumor)\|url=http://www.scielo.org.co/pdf/rcg/v26n2/en_v26n2a08.pdf\|journal=Col Gastroenterol\|volume=26\|issue=2}}</ref> Gejala yang timbul bergantung pada lokasi tumor. Penderita kolangiokarsinoma di saluran empedu ekstrahepatik (di luar hati) lebih mungkin mengalami penyakit kuning, sedangkan penderita kolangiokarsinoma yang tumornya tumbuh pada saluran empedu di dalam hati lebih sering mengalami nyeri tanpa adanya penyakit kuning.<ref name=":7">{{Cite journal\|last=Nakeeb\|first=Attila\|last2=Pitt\|first2=Henry A.\|last3=Sohn\|first3=Taylor A.\|last4=Coleman\|first4=JoAnn\|last5=Abrams\|first5=Ross A.\|last6=Piantadosi\|first6=Steven\|last7=Hruban\|first7=Ralph H.\|last8=Lillemoe\|first8=Keith D.\|last9=Yeo\|first9=Charles J.\|date=1996-10\|title=Cholangiocarcinoma: A Spectrum of Intrahepatic, Perihilar, and Distal Tumors\|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1235406/pdf/annsurg00032-0063.pdf\|journal=Annals of Surgery\|language=en-US\|volume=224\|issue=4\|pages=463–475\|doi=10.1097/00000658-199610000-00005\|issn=0003-4932\|pmc=PMC1235406\|pmid=8857851}}</ref> Tes fungsi hati pada orang dengan kolangiokarsinoma sering menunjukkan apa yang disebut "gambaran obstruktif", dengan peningkatan kadar [[bilirubin]], alkalin fosfatase, dan gama glutamil transferase, dan kadar transaminase yang relatif normal. Temuan laboratorium tersebut menunjukkan terjadinya obstruksi saluran empedu sebagai penyebab utama penyakit kuning bukan peradangan atau infeksi parenkim hati.<ref>{{Cite journal\|last=Roche\|first=Sean P.\|last2=Kobos\|first2=Rebecca\|date=2004\|title=Jaundice in the Adult Patient\|url=https://www.aafp.org/afp/2004/0115/afp20040115p299.pdf\|journal=American Family Physician\|volume=69\|issue=2\|access-date=2022-02-20\|archive-date=2022-03-03\|archive-url=https://web.archive.org/web/20220303084806/https://www.aafp.org/afp/2004/0115/afp20040115p299.pdf\|dead-url=yes}}</ref><ref>{{Cite journal\|last=Fargo\|first=Matthew V.\|last2=Grogan\|first2=Scott P.\|last3=Saguil\|first3=Aaron\|date=2017\|title=Evaluation of Jaundice in Adults\|url=https://www.aafp.org/afp/2017/0201/afp20170201p164.pdf\|journal=American Family Physician\|volume=95\|issue=3\|access-date=2022-02-20\|archive-date=2022-02-20\|archive-url=https://web.archive.org/web/20220220113833/https://www.aafp.org/afp/2017/0201/afp20170201p164.pdf\|dead-url=yes}}</ref> [[Berkas:Clonorchis sinensis LifeCycle.png\|jmpl\|Siklus hidup dari ''[[:en:Clonorchis_sinensis\|Clonorchis sinensis]]'', [[cacing hati]] yang terkait dengan kolangiokarsinoma]] Baris 43 ⟶ 42: Penyakit [[hati]] yang disebabkan oleh [[parasit]] tertentu dapat juga menjadi faktor risiko dari kolangiokarsinoma. Kolonisasi dengan [[cacing hati]] ''[[Opisthorchis viverrini\|Opisthorchis viverrine]]'' (ditemukan di [[Thailand]], [[Laos]], dan [[Vietnam]])<ref>{{Cite journal\|last=Watanapa\|first=P\|last2=Watanapa\|first2=W B\|date=2002-08-01\|title=Liver fluke-associated cholangiocarcinoma\|url=https://doi.org/10.1046/j.1365-2168.2002.02143.x\|journal=British Journal of Surgery\|volume=89\|issue=8\|pages=962–970\|doi=10.1046/j.1365-2168.2002.02143.x\|issn=0007-1323}}</ref><ref>{{Cite journal\|last=Sripa\|first=Banchob\|last2=Kaewkes\|first2=Sasithorn\|last3=Sithithaworn\|first3=Paiboon\|last4=Mairiang\|first4=Eimorn\|last5=Laha\|first5=Thewarach\|last6=Smout\|first6=Michael\|last7=Pairojkul\|first7=Chawalit\|last8=Bhudhisawasdi\|first8=Vajaraphongsa\|last9=Tesana\|first9=Smarn\|date=2007-07-10\|title=Liver Fluke Induces Cholangiocarcinoma\|url=https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.0040201&type=printable\|journal=PLOS Medicine\|language=en\|volume=4\|issue=7\|pages=e201\|doi=10.1371/journal.pmed.0040201\|issn=1549-1676\|pmc=PMC1913093\|pmid=17622191}}</ref> atau ''[[:en:Clonorchis_sinensis\|Clonorchis sinensis]]'' (ditemukan di [[Tiongkok\|Cina]], [[Republik Tiongkok\|Taiwan]], [[Rusia Timur Jauh\|Rusia Timur]], [[Korea]], dan [[Vietnam]])<ref>{{Cite book\|last=Locke\|first=Victoria\|last2=Kusnik\|first2=Alexander\|last3=Richardson\|first3=Melissa S.\|date=2022-01-09\|url=https://www.ncbi.nlm.nih.gov/books/NBK532892/\|title=Clonorchis Sinensis\|publisher=StatPearls Publishing\|language=en\|pmid=30422487}}</ref><ref>{{Cite journal\|last=Kim\|first=Tong-Soo\|last2=Pak\|first2=Jhang Ho\|last3=Kim\|first3=Jong-Bo\|last4=Bahk\|first4=Young Yil\|date=2016-11-30\|title=Clonorchis sinensis, an oriental liver fluke, as a human biological agent of cholangiocarcinoma: a brief review\|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5346318/pdf/bmb-49-590.pdf\|journal=BMB Reports\|language=en\|volume=49\|issue=11\|pages=590–597\|doi=10.5483/BMBRep.2016.49.11.109\|issn=1976-6696\|pmc=PMC5346318\|pmid=27418285}}</ref> telah dikaitkan dengan perkembangan kolangiokarsinoma. Program pengendalian (''Integrated Opisthorchiasis Control Program'') yang bertujuan untuk mengurangi konsumsi makanan mentah dan setengah matang telah berhasil menurunkan angka kejadian kolangiokarsinoma di beberapa negara.<ref>{{Cite journal\|last=Sripa\|first=Banchob\|last2=Tangkawattana\|first2=Sirikachorn\|last3=Sangnikul\|first3=Thinnakorn\|date=2017-08-01\|title=The Lawa model: A sustainable, integrated opisthorchiasis control program using the EcoHealth approach in the Lawa Lake region of Thailand\|url=https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC5443708&blobtype=pdf\|journal=Parasitology International\|series=Special Issue: Opisthorchiasis: 100 Years of Discovery\|language=en\|volume=66\|issue=4\|pages=346–354\|doi=10.1016/j.parint.2016.11.013\|issn=1383-5769\|pmc=PMC5443708\|pmid=27890720}}</ref> Orang dengan penyakit hati kronis, baik berupa [[hepatitis]] akibat [[virus]] (misalnya [[hepatitis B]] atau [[hepatitis C]]),<ref>{{Cite journal\|last=Kobayashi\|first=Masahiro\|last2=Ikeda\|first2=Kenji\|last3=Saitoh\|first3=Satoshi\|last4=Suzuki\|first4=Fumitaka\|last5=Tsubota\|first5=Akihito\|last6=Suzuki\|first6=Yoshiyuki\|last7=Arase\|first7=Yasuji\|last8=Murashima\|first8=Naoya\|last9=Chayama\|first9=Kazuaki\|date=2000\|title=Incidence of primary cholangiocellular carcinoma of the liver in Japanese patients with hepatitis C virus–related cirrhosis\|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/1097-0142%2820000601%2988%3A11%3C2471%3A%3AAID-CNCR7%3E3.0.CO%3B2-T\|journal=Cancer\|language=en\|volume=88\|issue=11\|pages=2471–2477\|doi=10.1002/1097-0142(20000601)88:11<2471::AID-CNCR7>3.0.CO;2-T\|issn=1097-0142}}</ref><ref>{{Cite journal\|last=Yamamoto\|first=Satoshi\|last2=Kubo\|first2=Shoji\|last3=Hai\|first3=Seikan\|last4=Uenishi\|first4=Takahiro\|last5=Yamamoto\|first5=Takatsugu\|last6=Shuto\|first6=Taichi\|last7=Takemura\|first7=Shigekazu\|last8=Tanaka\|first8=Hiromu\|last9=Yamazaki\|first9=Osamu\|date=2004\|title=Hepatitis C virus infection as a likely etiology of intrahepatic cholangiocarcinoma\|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1349-7006.2004.tb02492.x\|journal=Cancer Science\|language=en\|volume=95\|issue=7\|pages=592–595\|doi=10.1111/j.1349-7006.2004.tb02492.x\|issn=1349-7006}}</ref><ref>{{Cite journal\|last=Huiying\|first=Lu\|last2=Ye\|first2=Michele Q.\|last3=Thung\|first3=Swan N.\|last4=Dash\|first4=Srikanta\|last5=Gerber\|first5=Michael A.\|date=2000\|title=Detection of hepatitis C virus RNA sequences in cholangiocarcinomas in Chinese and American patients\|url=https://medcentral.net/doi/pdf/10.3760/cma.j.issn.0366-6999.2000.12.116\|journal=Chinese Medical Journal\|volume=113\|issue=12\|pages=1138-1141\|doi=https://doi.org/10.3760/cma.j.issn.0366-6999.2000.12.116}}</ref> penyakit hati pada [[alkoholik]], atau [[sirosis hati]], secara signifikan meningkatkan risiko kolangiokarsinoma.<ref name=":9">{{Cite journal\|last=Shaib\|first=Yasser H.\|last2=El-Serag\|first2=Hashem B.\|last3=Davila\|first3=Jessica A.\|last4=Morgan\|first4=Robert\|last5=McGlynn\|first5=Katherine A.\|date=2005-03-01\|title=Risk factors of intrahepatic cholangiocarcinoma in the United States: A case-control study\|url=https://www.gastrojournal.org/article/S0016-5085(04)02351-0/abstract\|journal=Gastroenterology\|language=English\|volume=128\|issue=3\|pages=620–626\|doi=10.1053/j.gastro.2004.12.048\|issn=0016-5085\|pmid=15765398}}</ref><ref>{{Cite journal\|last=Sørensen\|first=Henrik Toft\|last2=Friis\|first2=Søren\|last3=Olsen\|first3=Jørgen H.\|last4=Thulstrup\|first4=Ane Marie\|last5=Mellemkjær\|first5=Lene\|last6=Linet\|first6=Martha\|last7=Trichopoulos\|first7=Dimitrios\|last8=Vilstrup\|first8=Hendrik\|last9=Olsen\|first9=Jørn\|date=1998\|title=Risk of liver and other types of cancer in patients with cirrhosis: A nationwide cohort study in Denmark\|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/hep.510280404\|journal=Hepatology\|language=en\|volume=28\|issue=4\|pages=921–925\|doi=10.1002/hep.510280404\|issn=1527-3350}}</ref> Infeksi [[HIV]] juga teridentifikasi dalam satu penelitian sebagai faktor risiko potensial untuk kolangiokarsinoma, meskipun tidak jelas apakah penyebab utamanya adalah HIV itu sendiri atau terdapat faktor lain yang berkorelasi (misalnya infeksi [[hepatitis C]]). Infeksi bakteri ''[[:en:Helicobacter_bilis\|Helicobacter bilis]]'' dan ''[[:en:Helicobacter_hepaticus\|Helicobacter hepaticus]]'' dapat menyebabkan kanker [[saluran empedu]].<ref>{{Cite journal\|last=Chang\|first=Alicia H.\|last2=Parsonnet\|first2=Julie\|date=2010-October\|title=Role of Bacteria in Oncogenesis\|url=https://journals.asm.org/doi/abs/10.1128/CMR.00012-10\|journal=Clinical Microbiology Reviews\|language=EN\|doi=10.1128/CMR.00012-10\|pmc=PMC2952975\|pmid=20930075\|access-date=2022-02-10\|archive-date=2022-02-10\|archive-url=https://web.archive.org/web/20220210132139/https://journals.asm.org/doi/abs/10.1128/CMR.00012-10\|dead-url=yes}}</ref> Abnormalitas bawaan pada hati, seperti [[:en:Caroli_disease\|penyakit Caroli]] (tipe spesifik dari lima kista koledokus yang dikenali), telah dikaitkan sebagai faktor risiko dari kolangiokarsinoma sebesar 15%.<ref>{{Cite journal\|last=Lipsett\|first=Pamela A.\|last2=Pitt\|first2=Henry A.\|last3=Colombani\|first3=Paul M.\|last4=Boitnott\|first4=John K.\|last5=Cameron\|first5=John L.\|date=1994-11\|title=Choledochal Cyst Disease A Changing Pattern of Presentation\|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1234452/pdf/annsurg00057-0056.pdf\|journal=Annals of Surgery\|language=en-US\|volume=220\|issue=5\|pages=644–652\|doi=10.1097/00000658-199411000-00007\|issn=0003-4932\|pmc=PMC1234452\|pmid=7979612}}</ref><ref>{{Cite journal\|last=Rahman\|first=Sabrina\|last2=Sayeed\|first2=S K Jakaria Been\|last3=Chowdhury\|first3=Mostofa Kamal\|date=2019-01-01\|title=Caroli’s Disease: A premalignant condition?\|url=https://www.banglajol.info/index.php/JOM/article/view/38865\|journal=Journal of Medicine\|volume=20\|issue=1\|pages=55–56\|doi=10.3329/jom.v20i1.38865\|issn=2075-5384}}</ref> [[Kelainan bawaan]] langka [[:en:Lynch_syndrome\|sindrom Lynch]] II dan ''biliary papillomatosis'' juga telah ditemukan terkait dengan kolangiokarsinoma.<ref>{{Cite journal\|last=Mecklin\|first=J.-P.\|last2=Järvinen\|first2=H. J.\|last3=Virolainen\|first3=M.\|date=1992\|title=The association between cholangiooaroinoma and hereditary nonpolyposis colorectal carcinoma\|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/cncr.2820690508\|journal=Cancer\|language=en\|volume=69\|issue=5\|pages=1112–1114\|doi=10.1002/cncr.2820690508\|issn=1097-0142}}</ref><ref>{{Cite journal\|last=Lee\|first=Sang Soo\|last2=Kim\|first2=Myung-Hwan\|last3=Lee\|first3=Sung Koo\|last4=Jang\|first4=Se Jin\|last5=Song\|first5=Moon-Hee\|last6=Kim\|first6=Kyu-Pyo\|last7=Kim\|first7=Hong Ja\|last8=Seo\|first8=Dong-Wan\|last9=Song\|first9=Dong Eun\|date=2004\|title=Clinicopathologic review of 58 patients with biliary papillomatosis\|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/cncr.20031\|journal=Cancer\|language=en\|volume=100\|issue=4\|pages=783–793\|doi=10.1002/cncr.20031\|issn=1097-0142}}</ref> Adanya [[batu empedu]] (''[[:en:Cholelithiasis\|cholelithiasis]]'') tidak jelas kaitannya dengan kolangiokarsinoma. Namun, penyakit batu intrahepatik (disebut [[:en:Hepatolithiasis\|hepatolitiasis]]), yang tidak umum terjadi di negara Barat tetapi umum di beberapa bagian [[Asia]], sangat terkait dengan kolangiokarsinoma.<ref>{{Cite journal\|last=Su\|first=C-H\|last2=Shyr\|first2=Y-M\|last3=Lui\|first3=W-Y\|last4=P'Eng\|first4=F-K\|date=1997-07-01\|title=Hepatolithiasis associated with cholangiocarcinoma\|url=https://doi.org/10.1002/bjs.1800840717\|journal=British Journal of Surgery\|volume=84\|issue=7\|pages=969–973\|doi=10.1002/bjs.1800840717\|issn=0007-1323}}</ref><ref>{{Cite journal\|last=Kim\|first=Hyo Jung\|date=2015\|title=Hepatolithiasis and intrahepatic cholangiocarcinoma: A review\|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4690170/pdf/WJG-21-13418.pdf\|journal=World Journal of Gastroenterology\|language=en\|volume=21\|issue=48\|pages=13418\|doi=10.3748/wjg.v21.i48.13418\|issn=1007-9327\|pmc=PMC4690170\|pmid=26730152}}</ref><ref>{{Cite journal\|last=Jiang\|first=Wei\|last2=Deng\|first2=Xiaofei\|last3=Zhu\|first3=Ting\|last4=Wei\|first4=Yuya\|last5=Lei\|first5=Zhen\|last6=Guo\|first6=Meimei\|last7=Yang\|first7=Jiong\|date=2020-03-12\|title=Identification of Cholangiocarcinoma Associated with Hepatolithiasis via the Combination of miRNA and Ultrasound\|url=https://www.dovepress.com/identification-of-cholangiocarcinoma-associated-with-hepatolithiasis-v-peer-reviewed-fulltext-article-CMAR\|journal=Cancer Management and Research\|language=English\|volume=12\|pages=1845–1853\|doi=10.2147/CMAR.S241870\|pmc=PMC7075433\|pmid=32210627}}</ref> Paparan [[:en:Thorotrast\|Thorotrast]], suatu bentuk [[Torium dioksida\|thorium dioksida]] yang digunakan sebagai media kontras radiologis, telah dikaitkan dengan perkembangan kolangiokarsinoma hingga 30-40 tahun setelah paparan. Thorotrast dilarang di [[Amerika Serikat]] pada 1950-an karena [[karsinogen]]<nowiki/>isitasnya.<ref>{{Cite journal\|last=Levy\|first=Dw\|last2=Rindsberg\|first2=S\|last3=Friedman\|first3=Ac\|last4=Fishman\|first4=Ek\|last5=Ros\|first5=Pr\|last6=Radecki\|first6=Pd\|last7=Siegelman\|first7=Ss\|last8=Goodman\|first8=Zd\|last9=Pyatt\|first9=Rs\|date=1986\|title=Thorotrast-induced hepatosplenic neoplasia: CT identification\|url=https://www.ajronline.org/doi/pdf/10.2214/ajr.146.5.997\|journal=American Journal of Roentgenology\|language=en\|volume=146\|issue=5\|pages=997–1004\|doi=10.2214/ajr.146.5.997\|issn=0361-803X}}</ref><ref>{{Cite journal\|last=Liu\|first=Duo\|last2=Momoi\|first2=Hirohito\|last3=Li\|first3=Li\|last4=Ishikawa\|first4=Yuichi\|last5=Fukumoto\|first5=Manabu\|date=2002-12-01\|title=Microsatellite instability in thorotrast-induced human intrahepatic cholangiocarcinoma\|url=https://onlinelibrary.wiley.com/doi/10.1002/ijc.10726\|journal=International Journal of Cancer\|language=en\|volume=102\|issue=4\|pages=366–371\|doi=10.1002/ijc.10726\|issn=0020-7136}}</ref> == Patofisiologi == [[Berkas:Digestive system showing bile duct.svg\|jmpl\|Diagram [[sistem pencernaan]] yang menunjukkan lokasi [[saluran empedu]]]]Kolangiokarsinoma dapat mempengaruhi area di [[saluran empedu]], baik di dalam maupun di luar [[hati]]. [[Tumor]] yang terjadi di saluran empedu di dalam hati disebut sebagai intrahepatik, sementara yang terjadi di saluran di luar hati adalah ekstrahepatik, dan tumor yang terjadi di tempat keluarnya saluran empedu dari hati dapat disebut sebagai perihilar. Kolangiokarsinoma yang terjadi pada pertemuan di mana duktus hepatik bagian kiri dan kanan bertemu untuk membentuk [[:en:Common_hepatic_duct\|duktus hepatikus]] dapat disebut sebagai [[:en:Klatskin_tumor\|tumor Klatskin]].<ref>{{Cite journal\|last=Patel\|first=Tushar\|date=2011-04\|title=Cholangiocarcinoma—controversies and challenges\|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3888819/pdf/nihms533803.pdf\|journal=Nature Reviews Gastroenterology & Hepatology\|language=en\|volume=8\|issue=4\|pages=189–200\|doi=10.1038/nrgastro.2011.20\|issn=1759-5045\|pmc=PMC3888819\|pmid=21460876}}</ref> Meskipun kolangiokarsinoma diketahui memiliki gambaran [[Histologi\|histologis]] dan molekuler dari [[:en:Adenocarcinoma\|adenokarsinoma]] [[sel epitel]] yang melapisi saluran empedu, asal [[Sel (biologi)\|sel]] sebenarnya tidak diketahui. Bukti terbaru menunjukkan bahwa sel transformasi awal yang menghasilkan [[tumor]] primer mungkin muncul dari [[sel punca]] pluripoten hepatik.<ref>{{Cite journal\|last=Roskams\|first=T.\|date=2006-06\|title=Liver stem cells and their implication in hepatocellular and cholangiocarcinoma\|url=https://www.nature.com/articles/1209558\|journal=Oncogene\|language=en\|volume=25\|issue=27\|pages=3818–3822\|doi=10.1038/sj.onc.1209558\|issn=1476-5594}}</ref><ref>{{Cite journal\|last=Liu\|first=Chao\|date=2004\|title=Possible stem cell origin of human cholangiocarcinoma\|url=http://www.wjgnet.com/1007-9327/full/v10/i22/3374.htm\|journal=World Journal of Gastroenterology\|language=en\|volume=10\|issue=22\|pages=3374\|doi=10.3748/wjg.v10.i22.3374\|issn=1007-9327\|pmc=PMC4572317\|pmid=15484322}}</ref><ref>{{Cite journal\|last=Sell\|first=S.\|last2=Dunsford\|first2=H. A.\|date=1989\|title=Evidence for the stem cell origin of hepatocellular carcinoma and cholangiocarcinoma.\|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1879951/\|journal=The American Journal of Pathology\|volume=134\|issue=6\|pages=1347–1363}}</ref> Kolangiokarsinoma diperkirakan berkembang melalui serangkaian tahap dari [[Hiperplasi\|hiperplasia]] dan [[metaplasia]] dini, melalui [[displasia]], hingga perkembangan karsinoma yang nyata dalam proses yang serupa dengan yang terlihat pada perkembangan [[kanker usus besar]].<ref name=":5">{{Cite journal\|last=Sirica\|first=Alphonse E.\|date=2005\|title=Cholangiocarcinoma: Molecular targeting strategies for chemoprevention and therapy\|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/hep.20537\|journal=Hepatology\|language=en\|volume=41\|issue=1\|pages=5–15\|doi=10.1002/hep.20537\|issn=1527-3350}}</ref> Peradangan kronis dan obstruksi saluran empedu, dan aliran empedu yang terganggu, dianggap berperan dalam perkembangan kolangiokarsinoma.<ref name=":5" /><ref>{{Cite journal\|last=Holzinger\|first=F.\|last2=Z'graggen\|first2=K.\|last3=Buchler\|first3=M.W.\|date=1999\|title=Mechanisms of biliary carcinogenesis: A pathogenetic multi-stage cascade towards cholangiocarcinoma\|url=https://www.annalsofoncology.org/article/S0923-7534(20)31124-8/pdf\|journal=Annals of Oncology\|volume=10\|issue=4}}</ref><ref>{{Cite journal\|last=Gores\|first=G\|date=2003-05\|title=Cholangiocarcinoma: Current concepts and insights\|url=https://doi.org/10.1053/jhep.2003.50200\|journal=Hepatology\|volume=37\|issue=5\|pages=961–969\|doi=10.1053/jhep.2003.50200\|issn=0270-9139}}</ref> Secara histologis, kolangiokarsinoma dapat bervariasi mulai dari tidak berdiferensiasi hingga berdiferensiasi dengan baik. Sel-sel kanker tersebut sering dikelilingi oleh respons jaringan fibrotik atau desmoplastik yang cepat dengan adanya [[fibrosis]] yang luas sehingga akan sulit untuk membedakan kolangiokarsinoma yang berdiferensiasi dengan baik dari epitel normal. Tidak ada pewarnaan imunohistokimia yang sepenuhnya spesifik yang dapat membedakan jaringan ganas pada kantong empedu dari jaringan jinak pada kantong empedu. Namun, pewarnaan untuk [[:en:Cytokeratin\|sitokeratin]], [[antigen karsinoembrionik]], dan [[:en:Mucin\|musin]] dapat membantu dalam diagnosis.<ref>{{Cite journal\|last=Ward\|first=Stephen C.\|last2=Huang\|first2=Jiaoti\|last3=Tickoo\|first3=Satish K.\|last4=Thung\|first4=Swan N.\|last5=Ladanyi\|first5=Marc\|last6=Klimstra\|first6=David S.\|date=2010-09\|title=Fibrolamellar carcinoma of the liver exhibits immunohistochemical evidence of both hepatocyte and bile duct differentiation\|url=https://www.nature.com/articles/modpathol2010105\|journal=Modern Pathology\|language=en\|volume=23\|issue=9\|pages=1180–1190\|doi=10.1038/modpathol.2010.105\|issn=1530-0285}}</ref> Sebagian besar [[tumor]] yang terbentuk (>90%) adalah [[:en:Adenocarcinoma\|adenokarsinoma]].<ref name=":10">{{Cite journal\|last=Henson\|first=Donald Earl\|last2=Albores-Saavedra\|first2=Jorge\|last3=Corle\|first3=Donald\|date=1992\|title=Carcinoma of the extrahepatic bile ducts. Histologic types, stage of disease, grade, and survival rates\|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/1097-0142%2819920915%2970%3A6%3C1498%3A%3AAID-CNCR2820700609%3E3.0.CO%3B2-C\|journal=Cancer\|language=en\|volume=70\|issue=6\|pages=1498–1501\|doi=10.1002/1097-0142(19920915)70:6<1498::AID-CNCR2820700609>3.0.CO;2-C\|issn=1097-0142}}</ref> Baris 55 ⟶ 54: === Tes darah === [[Berkas:Cholangiocarcinoma - high mag.jpg\|jmpl\|Mikrograf intrahepatik, yaitu di dalam [[hati]], kolangiokarsinoma (sebelah kanan dari gambar); [[hepatosit]] jinak terlihat (gambar sebelah kiri). Secara histologis, gambar ini menunjukkan kolangiokarsinoma sebagai (1) sel [[saluran empedu]] yang tidak normal (gambar sebelah kiri) memanjang dari [[tumor]] dalam septum interlobular (lokasi anatomi normal saluran empedu) dan (2) tumor yang memiliki stroma desmoplastik berlimpah yang sering terlihat pada kolangiokarsinoma. [[:en:Portal_triad\|Portal triad]] (gambar sebelah kiri atas) memiliki saluran empedu yang normal secara histologis. \|195x195px]]Tidak ada [[:en:Blood_test\|tes darah]] khusus yang dapat dilakukan mendiagnosis kolangiokarsinoma. Pada kondisi kolangiokarsinoma, kadar [[:en:Carcinoembryonic_antigen\|serum antigen karsinoembrionik]] (CEA) dan [[:en:CA19-9\|CA19-9]] sering kali mengalami peningkatan, tetapi hal tersebut tidak cukup sensitif atau spesifik untuk digunakan sebagai alat skrining umum. Namun, penentuan kadar serum antigen karsinoembrionik (CEA) dan CA19-9 dapat berguna pada metode pencitraan dalam mendukung diagnosis kolangiokarsinoma.<ref>{{Cite journal\|last=Coelho\|first=Rosa\|last2=Silva\|first2=Marco\|last3=Rodrigues-Pinto\|first3=Eduardo\|last4=Cardoso\|first4=Hélder\|last5=Lopes\|first5=Susana\|last6=Pereira\|first6=Pedro\|last7=Vilas-Boas\|first7=Filipe\|last8=Santos-Antunes\|first8=João\|last9=Costa-Maia\|first9=José\|date=2017\|title=CA 19-9 as a Marker of Survival and a Predictor of Metastization in Cholangiocarcinoma\|url=https://www.karger.com/Article/FullText/452691\|journal=GE - Portuguese Journal of Gastroenterology\|language=en\|volume=24\|issue=3\|pages=114–121\|doi=10.1159/000452691\|issn=2341-4545\|pmc=PMC5553366\|pmid=28848795}}</ref><ref>{{Cite journal\|last=Patel\|first=Anand H.\|last2=Harnois\|first2=Denise M.\|date=2000\|title=The Utility of CA 19-9 in the Diagnoses of Cholangiocarcinoma in Patients Without Primary Sclerosing Cholangitis\|url=https://www.darmzentrum-bern.ch/fileadmin/darmzentrum/Education/Bible_Class/2019/Gallbladder___Bile_Duct_Cancer/BC_2019-06-19_Milestonepaper_ca19_9.pdf\|journal=The American Journal of Gastroeneterology\|volume=95\|issue=1}}</ref> Baris 69 ⟶ 68: === Patologi === [[Berkas:ERCP cholangioca.jpg\|jmpl\|Gambar [[:en:Endoscopic_retrograde_cholangiopancreatography\|ERCP]] dari kolangiokarsinoma, menunjukkan penyempitan saluran empedu dan pelebaran saluran empedu proksimal]] Secara [[Histologi\|histologis]], kolangiokarsinoma secara klasik adalah adenokarsinoma yang berdiferensiasi baik hingga sedang. Imunohistokimia berguna dalam diagnosis dan dapat digunakan untuk membantu membedakan kolangiokarsinoma dari [[karsinoma]] hepatoseluler dan [[metastasis]] [[tumor]] gastrointestinal lainnya.<ref>{{Cite journal\|last=~~Länger~~Takahashi\|first=F.Yoshihisa\|last2=~~v. Wasielewski~~Dungubat\|first2=R.Erdenetsogt\|last3=~~Kreipe~~Kusano\|first3=~~H. H.~~Hiroyuki\|last4=Ganbat\|first4=Dariimaa\|last5=Tomita\|first5=Yasuhiko\|last6=Odgerel\|first6=Sarandelger\|last7=Fukusato\|first7=Toshio\|date=~~2006-07~~2021-01\|title=~~Bedeutung~~Application ~~der~~of ~~Immunhistochemie~~Immunohistochemistry ~~für~~in ~~die~~the ~~Diagnose~~Pathological ~~des~~Diagnosis ~~Cholangiokarzinoms~~of Liver Tumors\|url=https://~~doi~~www.~~org/10~~mdpi.~~1007~~com/~~s00292-006~~1422-~~0836-z~~0067/22/11/5780\|journal=~~Der~~International Journal of Molecular ~~Pathologe~~Sciences\|language=deen\|volume=2722\|issue=411\|pages=~~244–250~~5780\|doi=10.~~1007~~3390/~~s00292-006-0836-z~~ijms22115780\|issn=~~1432~~1422-~~1963~~0067\|pmc=PMC8198626\|pmid=34071338}}</ref> Kuretase sitologi yang sering kali dilakukan terkadang tidak dapat mendiagnosis<ref>{{Cite web\|last=Darwin\|first=Peter E.\|date=2022-01-12\|title=Cholangiocarcinoma\|url=https://emedicine.medscape.com/article/277393-overview\|website=medscape\|access-date=22-02-10}}</ref> karena tumor ini biasanya memiliki stroma desmoplastik yang tidak melepaskan sel tumor diagnostik melalui proses pengkuretan. === Penentuan stadium === Meskipun setidaknya ada tiga sistem penentuan stadium untuk kolangiokarsinoma (misalnya Bismuth, Blumgart, dan [[:en:American_Joint_Committee_on_Cancer\|American Joint Committee on Cancer]]), tidak ada yang terbukti berguna dalam memprediksi kelangsungan hidup.<ref>{{Cite journal\|last=~~Zervos~~Jarnagin\|first=~~Emmanuel~~William ER.\|last2=~~Osborne~~Fong\|first2=~~Dana~~Yuman\|last3=~~Goldin~~DeMatteo\|first3=~~Steven~~Ronald BP.\|last4=~~Villadolid~~Gonen\|first4=~~Desiree V.~~Mithat\|last5=~~Thometz~~Burke\|first5=~~Donald~~Edmund PC.\|last6=~~Durkin~~Bodniewicz\|first6=~~Alan~~Jessica\|last7=~~Carey~~Youssef\|first7=~~Larry C.~~Miranda\|last8=~~Rosemurgy~~Klimstra\|first8=~~Alexander~~David\|last9=Blumgart\|first9=Leslie SH.\|date=~~2005~~2001-~~11-01~~10\|title=~~Stage~~Staging, ~~does~~Resectability, ~~not~~and ~~predict~~Outcome ~~survival~~in ~~after~~225 ~~resection~~Patients ofWith ~~hilar~~Hilar ~~cholangiocarcinomas promoting an aggressive operative approach~~Cholangiocarcinoma:\|url=https://www.~~americanjournalofsurgery~~ncbi.~~com~~nlm.nih.gov/~~article~~pmc/~~S0002-9610(05)00653-7~~articles/~~abstract~~PMC1422074/pdf/20011000s00010p507.pdf\|journal=~~The American Journal~~Annals of Surgery\|language=~~English~~en\|volume=~~190~~234\|issue=54\|pages=~~810–815~~507–519\|doi=10.~~1016~~1097/~~j.amjsurg.2005.07.025~~00000658-200110000-00010\|issn=~~0002~~0003-~~9610~~4932\|pmc=PMC1422074\|pmid=~~16226963~~11573044}}</ref> Masalah penentuan stadium yang paling penting adalah apakah tumor dapat diangkat melalui pembedahan atau apakah terlalu dini untuk melakukan pembedahan pada [[tumor]]. Seringkali, penentuan ini hanya dapat dilakukan pada saat pembedahan berlangsung.<ref name=":6" /> Pedoman umum untuk pembedahan meliputi:<ref>{{Cite journal\|last=Tsao\|first=Jane I.\|last2=Nimura\|first2=Yuji\|last3=Kamiya\|first3=Junichi\|last4=Hayakawa\|first4=Naokazu\|last5=Kondo\|first5=Satoshi\|last6=Nagino\|first6=Masato\|last7=Miyachi\|first7=Masahiko\|last8=Kanai\|first8=Michio\|last9=Uesaka\|first9=Katsuhiko\|date=2000-08\|title=Management of Hilar Cholangiocarcinoma: Comparison of an American and a Japanese Experience\|url=https://~~journals~~www.~~lww~~ncbi.~~com~~nlm.nih.gov/~~annalsofsurgery~~pmc/~~Abstract~~articles/~~2000~~PMC1421125/~~08000~~pdf/~~Management_of_Hilar_Cholangiocarcinoma__Comparison.3~~20000800s00003p166.~~aspx~~pdf\|journal=Annals of Surgery\|language=en-US\|volume=232\|issue=2\|pages=166–174\|doi=10.1097/00000658-200008000-00003\|issn=0003-4932\|pmc=PMC1421125\|pmid=10903592}}</ref><ref>{{Cite journal\|last=Rajagopalan\|first=Vandana\|last2=Grossbard\|first2=Michael L.\|last3=Kozuch\|first3=Peter\|date=2004\|title=Gallbladder and Biliary Tract Carcinoma: A Comprehensive Update, Part 1\|url=https://www.cancernetwork.com/view/~~journal~~gallbladder-~~looking~~and-~~ahead~~biliary-~~what~~tract-scarcinoma-~~next~~comprehensive-~~for~~update-~~hematology-oncology-in-2022~~part-1\|journal=Oncology\|language=en\|volume=18\|issue=7}}</ref> * Tidak adanya metastasis ke [[kelenjar getah bening]] atau [[hati]] Baris 84 ⟶ 83: == Pengobatan == [[Berkas:Cisplatin-3D-balls.png\|jmpl\|Cisplatin.]] Kolangiokarsinoma dianggap sebagai penyakit yang tidak dapat disembuhkan dan bersifat letal kecuali semua tumor dapat sepenuhnya direseksi (diangkat melalui pembedahan). Dalam beberapa kasus, kemampuan tumor untuk dapat dibedah hanya dapat diketahui selama pembedahan berlangsung,<ref>{{Cite journal\|last=Su\|first=Cheng-Hsi\|last2=Tsay\|first2=Shyh-Haw\|last3=Wu\|first3=Cheng-Chung\|last4=Shyr\|first4=Yi-Ming\|last5=King\|first5=Kuang-Liang\|last6=Lee\|first6=Chen-Hsen\|last7=Lui\|first7=Wing-Yiu\|last8=Liu\|first8=Tse-Jia\|last9=P'eng\|first9=Fang-Ku\|date=1996-04\|title=Factors Influencing Postoperative Morbidity, Mortality, and Survival After Resection for Hilar Cholangiocarcinoma\|url=https://~~journals~~www.~~lww~~ncbi.~~com~~nlm.nih.gov/~~annalsofsurgery~~pmc/~~Abstract~~articles/~~1996~~PMC1235134/~~04000~~pdf/~~Factors_Influencing_Postoperative_Morbidity,.7~~annsurg00038-0048.~~aspx~~pdf\|journal=Annals of Surgery\|language=en-US\|volume=223\|issue=4\|pages=384–394\|doi=10.1097/00000658-199604000-00007\|issn=0003-4932\|pmc=PMC1235134\|pmid=8633917}}</ref> mayoritas penderita akan menjalani eksplorasi pembedahan kecuali terdapat indikasi yang jelas bahwa terhadap [[tumor]] tidak dapat dilakukan pembedahan.<ref name=":6" /> Namun, [[Mayo Clinic]] telah melaporkan keberhasilan yang signifikan dalam mengobati [[kanker]] [[saluran empedu]] dini dengan [[transplantasi]] [[hati]] menggunakan pendekatan protokol dan kriteria seleksi yang ketat.<ref>{{Cite journal\|last=Rosen\|first=C. B.\|last2=Heimbach\|first2=J. K.\|last3=Gores\|first3=G. J.\|date=2008-06-01\|title=Surgery for cholangiocarcinoma: the role of liver transplantation\|url=https://www.hpbonline.org/article/S1365-182X(15)30051-4/abstract\|journal=HPB\|language=English\|volume=10\|issue=3\|pages=186–189\|doi=10.1080/13651820801992542\|issn=1365-182X\|pmc=PMC2504373\|pmid=18773052}}</ref> [[:en:Adjuvant_therapy\|Terapi adjuvan]] diikuti dengan transplantasi hati dapat memiliki peran tertentu dalam pengobatan terhadap tumor yang tidak dapat dibedah pada beberapa kasus tertentu.<ref>{{Cite journal\|last=Heimbach\|first=Julie K.\|last2=Gores\|first2=Gregory J.\|last3=Haddock\|first3=Michael G.\|last4=Alberts\|first4=Steven R.\|last5=Pedersen\|first5=Rachel\|last6=Kremers\|first6=Walter\|last7=Nyberg\|first7=Scott L.\|last8=Ishitani\|first8=Michael B.\|last9=Rosen\|first9=Charles B.\|date=2006-12-27\|title=Predictors of Disease Recurrence Following Neoadjuvant Chemoradiotherapy and Liver Transplantation for Unresectable Perihilar Cholangiocarcinoma\|url=https://journals.lww.com/transplantjournal/Fulltext/2006/12270/Predictors_of_Disease_Recurrence_Following.34.aspx\|journal=Transplantation\|language=en-US\|volume=82\|issue=12\|pages=1703–1707\|doi=10.1097/01.tp.0000253551.43583.d1\|issn=0041-1337}}</ref> Terapi lokoregional termasuk kemoembolisasi transarterial (TACE), radioembolisasi transarterial (TARE), dan terapi ablasi memiliki peran dalam varian intrahepatik kolangiokarsinoma untuk memberikan [[perawatan paliatif]] atau penyembuhan potensial pada penderita kolangiokarsinoma yang bukan kandidat layak untuk dibedah.<ref>{{Cite journal\|last=Kuhlmann\|first=Jan B.\|last2=Blum\|first2=Hubert E.\|date=2013-05\|title=Locoregional therapy for cholangiocarcinoma\|url=https://~~journals~~www.~~lww~~ncbi.nlm.~~com~~nih.gov/~~co-gastroenterology~~pmc/~~Abstract~~articles/~~2013~~PMC5777616/~~05000~~pdf/~~Locoregional_therapy_for_cholangiocarcinoma~~hep-04-99.~~15.aspx~~pdf\|journal=Current Opinion in Gastroenterology\|language=en-US\|volume=29\|issue=3\|pages=324–328\|doi=10.1097/MOG.0b013e32835d9dea\|issn=0267-1379}}</ref> === Kemoterapi adjuvan dan terapi radiasi === Jika [[tumor]] dapat diangkat melalui [[pembedahan]], penderita akan menerima [[kemoterapi]] [[:en:Adjuvant_therapy\|adjuvan]] atau [[terapi radiasi]] setelah operasi untuk meningkatkan kemungkinan penyembuhan. Jika margin jaringan negatif (yaitu tumor telah dieksisi total), kemoterapi adjuvan tidak dapat dipasti manfaatnya. Hasil positif<ref>{{Cite journal\|last=~~Todoroki~~Doherty\|first=~~Takeshi~~Mark K.\|last2=~~Ohara~~Knox\|first2=~~Kiyoshi\|last3=Kawamoto\|first3=Toru\|last4=Koike\|first4=Naoto\|last5=Yoshida\|first5=Sadao\|last6=Kashiwagi\|first6=Hironobu\|last7=Otsuka\|first7=Masaaki\|last8=Fukao\|first8=Katashi~~Jennifer J.\|date=~~2000~~2016-~~02-01~~10\|title=~~Benefits~~Adjuvant oftherapy ~~adjuvant~~for ~~radiotherapy~~resected ~~after~~biliary ~~radical~~tract ~~resection of locally advanced main hepatic~~cancer: ~~duct~~a ~~carcinoma~~review\|url=https://~~www~~cco.~~redjournal~~amegroups.~~org~~com/article/~~S0360-3016(99)00472-1~~view/11561/~~abstract~~12687\|journal=~~International~~Chinese ~~Journal of Radiation~~Clinical Oncology~~, Biology, Physics\|language=English~~\|volume=465\|issue=35\|pages=~~581–587~~64–64\|doi=10.~~1016~~21037/~~S0360-3016(99)00472-1\|issn=0360-3016\|pmid=10701737}}</ref><ref>{{Cite journal\|last=Alden\|first=Mark E~~cco.~~\|last2=Mohiuddin\|first2=Mohammed\|date=1994-03-01\|title=The impact of radiation dose in combined external beam and intraluminal IR-192 brachytherapy for bile duct cancer\|url=https://www~~2016.~~redjournal~~08.org/article/0360-3016(94)90115-5/abstract\|journal=International Journal of Radiation Oncology, Biology, Physics\|language=English\|volume=28\|issue=4\|pages=945–951\|doi=10.1016/0360-3016(94)90115-5\|issn=0360-3016\|pmid=813844805}}</ref> dan negatif<ref name=":7" /><ref>{{Cite journal\|last=Gonzalez\|first=D.Gonziilez\|last2=Gouma\|first2=D.J.\|last3=Rauws\|first3=E.A.J.\|last4=Gulik\|first4=T.M. van\|last5=Bosma\|first5=A.\|last6=Koedooder\|first6=C.\|date=1999\|title=Role of radiotherapy, in particular intraluminal brachytherapy, in the treatment of proximal bile duct carcinoma\|url=https://www.annalsofoncology.org/article/S0923-7534(20)31148-0/pdf\|journal=Annals of Oncology\|volume=10\|issue=4}}</ref><ref>{{Cite journal\|last=Pitt\|first=Henry A.\|last2=Nakeeb\|first2=Attila\|last3=Abrams\|first3=Ross A.\|last4=Coleman\|first4=JoAnn\|last5=Piantadosi\|first5=Steven\|last6=Yeo\|first6=Charles J.\|last7=Lillemoe\|first7=Keith D.\|last8=Cameron\|first8=John L.\|date=1995-06\|title=Perihilar Cholangiocarcinoma Postoperative Radiotherapy Does Not Improve Survival\|url=https://~~journals~~www.~~lww~~ncbi.~~com~~nlm.nih.gov/~~annalsofsurgery~~pmc/~~Abstract~~articles/~~1995~~PMC1234714/~~06000~~pdf/~~Perihilar_Cholangiocarcinoma_Postoperative.17~~annsurg00052-0188.~~aspx~~pdf\|journal=Annals of Surgery\|language=en-US\|volume=221\|issue=6\|pages=788–802\|doi=10.1097/00000658-199506000-00017\|issn=0003-4932\|pmc=PMC1234714\|pmid=7794082}}</ref> dari terapi radiasi adjuvan telah dilaporkan dan tidak ada uji coba terkontrol acak prospektif yang telah dilakukan pada Maret 2007. Kemoterapi adjuvan tampaknya tidak efektif pada orang dengan tumor yang direseksi total. <ref>{{Cite journal\|last=Takada\|first=Tadahiro\|last2=Amano\|first2=Hodaka\|last3=Yasuda\|first3=Hideki\|last4=Nimura\|first4=Yuji\|last5=Matsushiro\|first5=Takashi\|last6=Kato\|first6=Hiroyuki\|last7=Nagakawa\|first7=Takukazu\|last8=Nakayama\|first8=Toshimichi\|date=2002\|title=Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma?\|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/cncr.10831\|journal=Cancer\|language=en\|volume=95\|issue=8\|pages=1685–1695\|doi=10.1002/cncr.10831\|issn=1097-0142}}</ref> Peran kemoradioterapi kombinasi dalam pengobatan terhadap kolangiokarsinoma masih belum jelas. Namun, jika margin jaringan tumor positif, menunjukkan bahwa tumor tidak sepenuhnya diangkat melalui pembedahan, maka terapi adjuvan dengan radiasi dan kemungkinan kemoterapi umumnya direkomendasikan berdasarkan data yang tersedia. === Pengobatan penyakit lebih lanjut === Mayoritas kasus pada kolangikarsinoma bersifat tidak dapat dilakukan pembedahan (tidak dapat dioperasi).<ref ~~name=":11"~~>{{Cite journal\|last=~~Vauthey~~Blechacz\|first=~~Jean-Nicolas~~Boris\|last2=~~Blumgart~~Gores\|first2=~~Leslie~~Gregory HJ.\|date=~~1994~~2008-0507\|title=~~Recent~~Cholangiocarcinoma: Advances in ~~the~~pathogenesis, ~~Management~~diagnosis, ofand ~~Cholangiocarcinomas~~treatment\|url=~~http~~https://www.~~thieme-connect~~ncbi.denlm.nih.gov/~~DOI~~pmc/~~DOI?10.1055~~articles/~~s-2007-1007302~~PMC2547491/pdf/nihms60349.pdf\|journal=~~Seminars in Liver Disease~~Hepatology\|language=en\|volume=1448\|issue=021\|pages=~~109–114~~308–321\|doi=10.~~1055~~1002/~~s-2007-1007302\|issn=0272-8087~~hep.22310}}</ref> Dalam hal ini, penderita umumnya diobati dengan [[kemoterapi]] [[Perawatan paliatif\|paliatif]], dengan atau tanpa [[radioterapi]]. Kemoterapi telah ditunjukkan dalam uji coba terkontrol secara acak untuk meningkatkan kualitas hidup dan memperpanjang kelangsungan hidup pada orang dengan kolangiokarsinoma yang tidak dapat dibedah.<ref>{{Cite journal\|last=Glimelius\|first=B.\|last2=Hoffman\|first2=K.\|last3=Sjödén\|first3=P.-O.\|last4=Jacobsson\|first4=G.\|last5=Sellström\|first5=H.\|last6=Enander\|first6=L.-K.\|last7=Linné\|first7=T.\|last8=Svensson\|first8=C.\|date=1996-08\|title=Chemotherapy improves survival and quality of life in advanced pancreatic and biliary cancer\|url=https://doi.org/10.1093/oxfordjournals.annonc.a010676\|journal=Annals of Oncology\|volume=7\|issue=6\|pages=593–600\|doi=10.1093/oxfordjournals.annonc.a010676\|issn=0923-7534}}</ref> Tidak ada panduan kemoterapi tunggal yang digunakan secara universal, dan pendaftaran dalam uji klinis sering direkomendasikan bila memungkinkan. Agen kemoterapi yang digunakan untuk mengobati kolangiokarsinoma termasuk [[Fluorourasil\|5-fluorourasil]] dengan [[:en:Leucovorin\|leucovorin]],<ref>{{Cite journal\|last=~~Choi~~Perkhofer\|first=~~Chul Won~~L.\|last2=~~Choi~~Berger\|first2=~~Keun~~A. W.\|last3=~~Seo~~Beutel\|first3=~~Jae~~A. ~~Hong~~K.\|last4=~~Kim~~Gallmeier\|first4=~~Byung Soo~~E.\|last5=~~Kim~~Angermeier\|first5=~~Jae Seon~~S.\|last6=~~Kim~~Fischer von Weikersthal\|first6=~~Chang Duk~~L.\|last7=UmGoetze\|first7=~~Soon~~T. HoO.\|last8=~~Kim~~Muche\|first8=~~Jun Suk~~R.\|last9=~~Kim~~Seufferlein\|first9=~~Yeul Hong~~T.\|date=~~2000~~2019-0810-23\|title=~~Effects~~Nal-IRI ofwith 5-~~Fluorouracil~~fluorouracil (5-FU) and ~~Leucovorin~~leucovorin or gemcitabine plus cisplatin in advanced biliary tract cancer - the ~~Treatment~~NIFE oftrial ~~Pancreatic–Biliary~~(AIO-YMO ~~Tract~~HEP-0315) ~~Adenocarcinomas~~an open label, non-comparative, randomized, multicenter phase II study\|url=https://~~journals~~bmccancer.~~lww~~biomedcentral.com/~~amjclinicaloncology~~track/~~Abstract~~pdf/~~2000/08000/Effects_of_5_Fluorouracil_and_Leucovorin_in_the~~10.231186/s12885-019-6142-y.~~aspx~~pdf\|journal=~~American~~BMC ~~Journal of Clinical Oncology\|language=en-US~~Cancer\|volume=2319\|issue=41\|pages=~~425–428~~990\|doi=10.~~1097~~1186/~~00000421~~s12885-~~200008000~~019-~~00023~~6142-y\|issn=~~0277~~1471-~~3732~~2407\|pmc=PMC6813114\|pmid=31646981}}</ref> [[gemsitabin]] sebagai agen tunggal,<ref>{{Cite journal\|last=Park\|first=Jong-Sung\|last2=Oh\|first2=Sung-Yong\|last3=Kim\|first3=Sung-Hyun\|last4=Kwon\|first4=Hyuk-Chan\|last5=Kim\|first5=Jae-Seok\|last6=Jin-Kim\|first6=Hyo\|last7=Kim\|first7=Young-Hoon\|date=2005-02-01\|title=Single-agent Gemcitabine in the Treatment of Advanced Biliary Tract Cancers: a Phase II Study\|url=https://doi.org/10.1093/jjco/hyi021\|journal=Japanese Journal of Clinical Oncology\|volume=35\|issue=2\|pages=68–73\|doi=10.1093/jjco/hyi021\|issn=0368-2811}}</ref> atau gemsitabin dan [[cisplatin]],<ref>{{Cite journal\|last=Giuliani\|first=F.\|last2=Gebbia\|first2=V.\|last3=Maiello\|first3=E.\|last4=Borsellino\|first4=N.\|last5=Bajardi\|first5=E.\|last6=Colucci\|first6=G.\|date=2006-06\|title=Gemcitabine and cisplatin for inoperable and/or metastatic biliary tree carcinomas: a multicenter phase II study of the Gruppo Oncologico dell'Italia Meridionale (GOIM)\|url=https://doi.org/10.1093/annonc/mdl956\|journal=Annals of Oncology\|volume=17\|pages=vii73–vii77\|doi=10.1093/annonc/mdl956\|issn=0923-7534}}</ref> [[:en:Irinotecan\|irinotecan]],<ref>{{Cite journal\|last=~~Bhargava~~Sohal\|first=~~Pankaj~~D.P.S.\|last2=~~Jani~~Mykulowycz\|first2=~~Chirag R~~K.\|last3=~~Savarese~~Uehara\|first3=~~Diane M. F~~T.\|last4=~~O’donnell~~Teitelbaum\|first4=~~Judith L~~U.R.\|last5=~~Stuart~~Damjanov\|first5=~~Keith E~~N.\|last6=~~Lima~~Giantonio\|first6=~~Caio Max S~~B.J.\|last7=Carberry\|first7=M.\|last8=Wissel\|first8=P.\|last9=Jacobs-Small\|first9=M. ~~Rocha~~\|date=~~2003~~2013-12\|title=~~Gemcitabine~~A ~~and~~phase ~~Irinotecan~~II intrial ~~Locally~~of ~~Advanced~~gemcitabine, oririnotecan ~~Metastatic~~and ~~Biliary~~panitumumab ~~Cancer:~~in ~~Preliminary~~advanced ~~Report~~cholangiocarcinoma\|url=https://www.~~cancernetwork~~annalsofoncology.~~com~~org/~~view~~action/~~gemcitabine~~showPdf?pii=S0923-~~and~~7534%2819%2936750-~~irinotecan-locally-advanced-or-metastatic-biliary-cancer-preliminary-report~~X\|journal=Annals of Oncology\|language=en\|volume=1724\|issue=912\|pages=3061–3065\|doi=10.1093/annonc/mdt416}}</ref> atau [[capecitabine]].<ref>{{Cite journal\|last=Knox\|first=Jennifer J.\|last2=Hedley\|first2=David\|last3=Oza\|first3=Amit\|last4=Feld\|first4=Ron\|last5=Siu\|first5=Lillian L.\|last6=Chen\|first6=Eric\|last7=Nematollahi\|first7=Mahsan\|last8=Pond\|first8=Gregory R.\|last9=Zhang\|first9=Jessica\|date=2005-04-01\|title=Combining Gemcitabine and Capecitabine in Patients With Advanced Biliary Cancer: A Phase II Trial\|url=https://ascopubs.org/doi/10.1200/JCO.2005.51.008\|journal=Journal of Clinical Oncology\|volume=23\|issue=10\|pages=2332–2338\|doi=10.1200/JCO.2005.51.008\|issn=0732-183X}}</ref> Dalam sebuah studi, dinyatakan adanya manfaat dari [[:en:Erlotinib\|erlotinib]] inhibitor tirosin kinase pada penderita kolangiokarsinoma tingkat lanjut.<ref>{{Cite journal\|last=Philip\|first=Philip A.\|last2=Mahoney\|first2=Michelle R.\|last3=Allmer\|first3=Cristine\|last4=Thomas\|first4=James\|last5=Pitot\|first5=Henry C.\|last6=Kim\|first6=George\|last7=Donehower\|first7=Ross C.\|last8=Fitch\|first8=Tom\|last9=Picus\|first9=Joel\|date=2006-07-01\|title=Phase II Study of Erlotinib in Patients With Advanced Biliary Cancer\|url=https://ascopubs.org/doi/10.1200/JCO.2005.05.3579\|journal=Journal of Clinical Oncology\|volume=24\|issue=19\|pages=3069–3074\|doi=10.1200/JCO.2005.05.3579\|issn=0732-183X}}</ref> Terapi radiasi diamati mampu memperpanjang kelangsungan hidup pada orang dengan kolangiokarsinoma ekstrahepatik yang direseksi,<ref>{{Cite journal\|last=Beltrán\|first=Marta Bonet\|last2=Allal\|first2=Abdelkarim S.\|last3=Gich\|first3=Ignasi\|last4=Solé\|first4=Josep M.\|last5=Carrió\|first5=Ignasi\|date=2012-04-01\|title=Is adjuvant radiotherapy needed after curative resection of extrahepatic biliary tract cancers? A systematic review with a meta-analysis of observational studies\|url=https://www.~~cancertreatmentreviews~~ncbi.~~com~~nlm.nih.gov/~~article~~books/~~S0305-7372(11)00080-6~~NBK91637/~~abstract~~\|journal=Cancer Treatment Reviews\|language=English\|volume=38\|issue=2\|pages=111–119\|doi=10.1016/j.ctrv.2011.05.003\|issn=0305-7372\|pmid=21652148}}</ref> dan beberapa laporan tentang penggunaannya pada kolangiokarsinoma yang tidak dapat direseksi menunjukkan peningkatan kelangsungan hidup, tetapi jumlahnya kecil.<ref name=":3" /> Infigratinib (Truseltiq) adalah [[:en:Tyrosine_kinase_inhibitor\|penghambat tirosin kinase]] dari [[:en:Fibroblast_growth_factor_receptor\|reseptor ''growth factor fibroblast'']] (FGFR) yang telah disetujui untuk penggunaan medis di [[Amerika Serikat]] pada Mei 2021.<ref name=":12">{{Cite web\|last=Inc\|first=BridgeBio Pharma\|date=2021-05-28\|title=BridgeBio Pharma’s Affiliate QED Therapeutics and Partner Helsinn Group Announce FDA Approval of TRUSELTIQ™ (infigratinib) for Patients with Cholangiocarcinoma\|url=https://www.globenewswire.com/news-release/2021/05/28/2238443/0/en/BridgeBio-Pharma-s-Affiliate-QED-Therapeutics-and-Partner-Helsinn-Group-Announce-FDA-Approval-of-TRUSELTIQ-infigratinib-for-Patients-with-Cholangiocarcinoma.html\|website=GlobeNewswire News Room\|language=en\|access-date=2022-02-11}}</ref> Infigranatinib diindikasikan untuk pengobatan penderita kolangiokarsinoma stadium lanjut atau metastasis yang sebelumnya diobati secara lokal di mana menyimpan fusi atau terjadi penataan ulang terhadap FGFR2.<ref name=":12" /> == Prognosis == Reseksi bedah merupakan satu-satunya kemungkinan penyembuhan yang potensial pada kolangiokarsinoma. Untuk kasus kolangiokarsinoma yang tidak dapat dibedah, tingkat kelangsungan hidup dalam lima tahun ke depan adalah 0% di mana penyakit ini tidak dapat dioperasi karena [[kelenjar getah bening]] distal menunjukkan [[metastasis]],<ref>{{Cite journal\|last=Yamamoto\|first=Masakazu\|last2=Takasaki\|first2=Ken\|last3=Yoshikawa\|first3=Tatsuya\|date=1999-03-01\|title=Lymph Node Metastasis in Intrahepatic Cholangiocarcinoma\|url=https://doi.org/10.1093/jjco/29.3.147\|journal=Japanese Journal of Clinical Oncology\|volume=29\|issue=3\|pages=147–150\|doi=10.1093/jjco/29.3.147\|issn=0368-2811}}</ref> dan kurang dari 5% pada umumnya.<ref>{{Cite journal\|last=~~Farley~~Lauterio\|first=~~David R.~~Andrea\|last2=~~Weaver~~De Carlis\|first2=~~Amy L.~~Riccardo\|last3=~~Nagorney~~Centonze\|first3=~~David~~Leonardo\|last4=Buscemi\|first4=Vincenzo\|last5=Incarbone\|first5=Niccolò\|last6=Vella\|first6=Ivan\|last7=De M.Carlis\|first7=Luciano\|date=~~1995-05~~2021-01\|title=~~“Natural~~Current ~~History”~~Surgical Management of ~~Unresected~~Peri-Hilar ~~Cholangiocarcinoma:~~and ~~Patient~~Intra-Hepatic ~~Outcome After Noncurative Intervention~~Cholangiocarcinoma\|url=https://www.~~mayoclinicproceedings~~mdpi.~~org~~com/~~article~~2072-6694/~~S0025-6196(11)63877-9~~13/15/3657/~~abstract~~pdf\|journal=~~Mayo Clinic Proceedings~~Cancers\|language=~~English~~en\|volume=7013\|issue=515\|pages=~~425–429~~3657\|doi=10.~~4065~~3390/~~70.5.425~~cancers13153657\|issn=~~0025~~2072-~~6196~~6694\|pmc=PMC8345178\|pmid=34359560}}</ref> Durasi rata-rata kelangsungan hidup keseluruhan kurang dari 6 bulan pada penderita yang tumornya sudah bermetastasis.<ref>{{Cite journal\|last=~~Grove~~Zhu\|first=~~Mark~~Andrew KX.\|last2=~~Hermann~~Macarulla\|first2=~~Robert E.~~Teresa\|last3=~~Vogt~~Javle\|first3=~~David~~Milind PM.\|last4=~~Broughan~~Kelley\|first4=~~Thomas~~R. AKate\|last5=Lubner\|first5=Sam J.\|last6=Adeva\|first6=Jorge\|last7=Cleary\|first7=James M.\|last8=Catenacci\|first8=Daniel V. T.\|last9=Borad\|first9=Mitesh J.\|date=~~1991~~2021-0411-01\|title=~~Role~~Final Overall Survival Efficacy Results of ~~radiation~~Ivosidenib ~~after~~for ~~operative~~Patients ~~palliation~~With inAdvanced ~~cancer~~Cholangiocarcinoma ofWith ~~the~~IDH1 ~~proximal~~Mutation: The Phase 3 Randomized Clinical ~~bile~~ClarIDHy ~~ducts~~Trial\|url=https://~~www~~doi.~~americanjournalofsurgery~~org/10.~~com~~1001/~~article~~jamaoncol.2021.3836\|journal=JAMA Oncology\|volume=7\|issue=11\|pages=1669–1677\|doi=10.1001/~~0002-9610(91)91111~~jamaoncol.2021.3836\|issn=2374-~~U/abstract~~2437\|pmc=PMC8461552\|pmid=34554208}}</ref><ref>{{Cite journal\|last=~~The~~Treeprasertsuk\|first=Sombat\|last2=Poovorawan\|first2=Kittiyod\|last3=Soonthornworasiri\|first3=Ngamphol\|last4=Chaiteerakij\|first4=Roongruedee\|last5=Thanapirom\|first5=Kessarin\|last6=Mairiang\|first6=Pisaln\|last7=Sawadpanich\|first7=Kookwan\|last8=Sonsiri\|first8=Kanokwan\|last9=Mahachai\|first9=Varocha\|date=2017-12\|title=A ~~American~~significant ~~Journal~~cancer burden and high mortality of ~~Surgery~~intrahepatic cholangiocarcinoma in Thailand: a nationwide database study\|url=https://bmcgastroenterol.biomedcentral.com/track/pdf/10.1186/s12876-016-0565-6.pdf\|journal=BMC Gastroenterology\|language=~~English~~en\|volume=~~161~~17\|issue=41\|pages=~~454–458~~3\|doi=10.~~1016~~1186/~~0002~~s12876-~~9610(91)91111~~016-U0565-6\|issn=~~0002~~1471-~~9610~~230X\|pmc=PMC5216607\|pmid=~~1709795~~28056836}}</ref> Untuk kasus kolangiokarsinoma yang dapat bedah, kemungkinan penyembuhan bervariasi tergantung pada lokasi [[tumor]] dan apakah tumor dapat diangkat seluruhnya, atau hanya sebagian. Kolangiokarsinoma distal (yang timbul dari saluran empedu umum) umumnya diobati dengan pembedahan dengan [[:en:Whipple_procedure\|prosedur Whipple]] di mana tingkat kelangsungan hidup jangka panjang berkisar dari 15 hingga 25%, meskipun dalam satu penelitian melaporkan kelangsungan hidup lima tahun 54% untuk penderita tanpa keterlibatan [[kelenjar getah bening]].<ref>{{Cite journal\|last=Nakeeb\|first=Attila\|last2=Pitt\|first2=Henry A.\|last3=Sohn\|first3=Taylor A.\|last4=Coleman\|first4=JoAnn\|last5=Abrams\|first5=Ross A.\|last6=Piantadosi\|first6=Steven\|last7=Hruban\|first7=Ralph H.\|last8=Lillemoe\|first8=Keith D.\|last9=Yeo\|first9=Charles J.\|date=1996-10\|title=Cholangiocarcinoma: A Spectrum of Intrahepatic, Perihilar, and Distal Tumors\|url=https://~~journals~~www.~~lww~~ncbi.nlm.~~com~~nih.gov/~~annalsofsurgery~~pmc/~~Abstract~~articles/~~1996~~PMC1235406/~~10000~~pdf/~~Cholangiocarcinoma__A_Spectrum_of_Intrahepatic,~~annsurg00032-0063.~~5.aspx~~pdf\|journal=Annals of Surgery\|language=en-US\|volume=224\|issue=4\|pages=463–475\|doi=10.1097/00000658-199610000-00005\|issn=0003-4932\|pmc=PMC1235406\|pmid=8857851}}</ref><ref>{{Cite journal\|last=Jang\|first=Jin-Young\|last2=Kim\|first2=Sun-Whe\|last3=Park\|first3=Do Joong\|last4=Ahn\|first4=Young Joon\|last5=Yoon\|first5=Yoo-Seok\|last6=Choi\|first6=Min Gew\|last7=Suh\|first7=Kyung-Suk\|last8=Lee\|first8=Kuhn Uk\|last9=Park\|first9=Yong-Hyun\|date=2005-01\|title=Actual Long-term Outcome of Extrahepatic Bile Duct Cancer After Surgical Resection\|url=https://~~journals~~www.~~lww~~ncbi.~~com~~nlm.nih.gov/~~annalsofsurgery~~pmc/~~Abstract~~articles/~~2005~~PMC1356849/~~01000~~pdf/~~Actual_Long_term_Outcome_of_Extrahepatic_Bile_Duct~~20050100s00011p77.~~11.aspx~~pdf\|journal=Annals of Surgery\|language=en-US\|volume=241\|issue=1\|pages=77–84\|doi=10.1097/01.sla.0000150166.94732.88\|issn=0003-4932\|pmc=PMC1356849\|pmid=15621994}}</ref><ref>{{Cite journal\|last=Bortolasi\|first=Luca\|last2=Burgart\|first2=Lawrence J.\|last3=Tsiotos\|first3=Gregory G.\|last4=León\|first4=Enrique Luque-de\|last5=Sarr\|first5=Michael G.\|date=2000\|title=Adenocarcinoma of the Distal Bile Duct\|url=https://www.karger.com/Article/FullText/18798\|journal=Digestive Surgery\|language=english\|volume=17\|issue=1\|pages=36–41\|doi=10.1159/000018798\|issn=0253-4886\|pmid=10720830}}</ref><ref>{{Cite journal\|last=Fong\|first=Y\|last2=Blumgart\|first2=L H\|last3=Lin\|first3=E\|last4=Fortner\|first4=J G\|last5=Brennan\|first5=M F\|date=1996-12-01\|title=Outcome of treatment for distal bile duct cancer\|url=https://doi.org/10.1002/bjs.1800831217\|journal=British Journal of Surgery\|volume=83\|issue=12\|pages=1712–1715\|doi=10.1002/bjs.1800831217\|issn=0007-1323}}</ref> Kolangiokarsinoma intrahepatik (yang timbul dari saluran empedu di dalam hati) biasanya diobati dengan [[hepatektomi]] parsial. Berbagai seri penelitian telah melaporkan perkiraan kelangsungan hidup setelah operasi mulai dari 22 hingga 66%. Hasil tersebut dapat bergantung pada keterlibatan kelenjar getah bening dan kelengkapan operasi.<ref>{{Cite journal\|last=Nakeeb\|first=Attila\|last2=Pitt\|first2=Henry A.\|last3=Sohn\|first3=Taylor A.\|last4=Coleman\|first4=JoAnn\|last5=Abrams\|first5=Ross A.\|last6=Piantadosi\|first6=Steven\|last7=Hruban\|first7=Ralph H.\|last8=Lillemoe\|first8=Keith D.\|last9=Yeo\|first9=Charles J.\|date=1996-10\|title=Cholangiocarcinoma: A Spectrum of Intrahepatic, Perihilar, and Distal Tumors\|url=https://journals.lww.com/annalsofsurgery/Abstract/1996/10000/Cholangiocarcinoma__A_Spectrum_of_Intrahepatic,.5.aspx\|journal=Annals of Surgery\|language=en-US\|volume=224\|issue=4\|pages=463–475\|doi=10.1097/00000658-199610000-00005\|issn=0003-4932\|pmc=PMC1235406\|pmid=8857851}}</ref><ref>{{Cite journal\|last=~~Lieser~~Mare\|first=~~Mark~~Giulio J.Di\|last2=~~Barry~~Marrelli\|first2=~~M. Kevin~~Daniele\|last3=~~Rowland~~Voglino\|first3=~~Charles~~Costantino\|last4=~~Ilstrup~~Ferrara\|first4=~~Duane M.~~Francesco\|last5=~~Nagorney~~Piagnerelli\|first5=David M.\|date=1998-04-01\|title=Surgical management of intrahepatic cholangiocarcinoma: A 31-year experience\|url=https://doi.org/10.1007/PL00009949\|journal=Journal of Hepato-Biliary-Pancreatic Surgery\|language=en\|volume=5\|issue=1\|pages=41–47\|doi=10.1007/PL00009949\|issn=1436-0691}}</ref><ref>{{Cite journal\|last=Valverde\|first=Alain\|last2=Bonhomme\|first2=Nicolas\|last3=Farges\|first3=Olivier\|last4=Sauvanet\|first4=Alain\|last5=Flejou\|first5=Jean F.Riccardo\|last6=~~Belghiti~~Marini\|first6=Jacques\|date=1999-07-01\|title=Resection of intrahepatic cholangiocarcinoma: a Western experience\|url=https://doi.org/10.1007/s005340050094\|journal=Journal of Hepato-Biliary-Pancreatic Surgery\|language=en\|volume=6\|issue=2\|pages=122–127\|doi=10.1007/s005340050094\|issn=1436-0691}}</ref><ref>{{Cite journal\|last=Nakagohri\|first=Toshio\|last2=Asano\|first2=Takehide\|last3=Kinoshita\|first3=Hirotoshi\|last4=Kenmochi\|first4=Takashi\|last5=Urashima\|first5=Tetsuro\|last6=Miura\|first6=FumihikoMario\|last7=~~Ochiai~~Roviello\|first7=~~Takenori~~Franco\|date=~~2003-03-01~~2018\|title=~~Aggressive~~Cholangiocarcinoma: ~~Surgical~~A ~~Resection for Hilar~~Single-~~invasive~~center ~~and~~Western ~~Peripheral Intrahepatic Cholangiocarcinoma~~Experience\|url=https://~~doi~~www.omicsonline.org/~~10.1007~~open-access/~~s00268~~cholangiocarcinoma-~~002~~a-~~6696~~singlecenter-~~7\|journal=World Journal of Surgery\|language=en\|volume=27\|issue=3\|pages=289–293\|doi=10.1007/s00268~~western-~~002~~experience-~~6696~~2168-~~7\|issn=1432~~9784-~~2323}}</ref><ref>{{Cite journal\|last=Weber\|first=S\|date=2001~~1000270-~~10\|title=Intrahepatic Cholangiocarcinoma: resectability, recurrence pattern, and outcomes\|url=https://doi~~101950.~~org/10.1016/S1072-7515(01)01016-X~~html\|journal=Journal of ~~the~~Medical ~~American College of~~Diagnostic ~~Surgeons~~Methods\|volume=~~193~~07\|issue=~~4\|pages=384–391~~02\|doi=10.~~1016~~4172/~~s1072~~2168-~~7515(01)01016-x\|issn=1072-7515~~9784.1000270}}</ref> Kolangiokarsinoma perihilar (yang terjadi di dekat tempat keluarnya [[saluran empedu]] dari [[hati]]) paling tidak mungkin dapat dioperasi. Ketika pembedahan memungkinkan, tumor umumnya diperlakukan dengan pendekatan agresif yang sering kali termasuk pengangkatan kantong empedu dan kemungkinan bagian dari hati. Pada pasien dengan tumor perihilar yang dapat dioperasi, tingkat kelangsungan hidup 5 tahun yang dilaporkan berkisar antara 20 hingga 50%.<ref>{{Cite journal\|last=Burke\|first=Edmund C.\|last2=Jarnagin\|first2=William R.\|last3=Hochwald\|first3=Steven N.\|last4=Pisters\|first4=Peter W. T.\|last5=Fong\|first5=Yuman\|last6=Blumgart\|first6=Leslie H.\|date=1998-09\|title=Hilar Cholangiocarcinoma: Patterns of Spread, the Importance of Hepatic Resection for Curative Operation, and a Presurgical Clinical Staging System\|url=https://~~journals~~www.~~lww~~ncbi.nlm.~~com~~nih.gov/~~annalsofsurgery~~pmc/~~Abstract~~articles/~~1998~~PMC1191497/~~09000~~pdf/~~Hilar_Cholangiocarcinoma__Patterns_of_Spread,_the~~annsurg00007-0125.~~11.aspx~~pdf\|journal=Annals of Surgery\|language=en-US\|volume=228\|issue=3\|pages=385–394\|doi=10.1097/00000658-199809000-00011\|issn=0003-4932\|pmc=PMC1191497\|pmid=9742921}}</ref><ref>{{Cite journal\|last=Tsao\|first=Jane I.\|last2=Nimura\|first2=Yuji\|last3=Kamiya\|first3=Junichi\|last4=Hayakawa\|first4=Naokazu\|last5=Kondo\|first5=Satoshi\|last6=Nagino\|first6=Masato\|last7=Miyachi\|first7=Masahiko\|last8=Kanai\|first8=Michio\|last9=Uesaka\|first9=Katsuhiko\|date=2000-08\|title=Management of Hilar Cholangiocarcinoma: Comparison of an American and a Japanese Experience\|url=https://journals.lww.com/annalsofsurgery/Abstract/2000/08000/Management_of_Hilar_Cholangiocarcinoma__Comparison.3.aspx\|journal=Annals of Surgery\|language=en-US\|volume=232\|issue=2\|pages=166–174\|doi=10.1097/00000658-200008000-00003\|issn=0003-4932\|pmc=PMC1421125\|pmid=10903592}}</ref><ref>{{Cite journal\|last=Chamberlain\|first=Ronald S.\|last2=Blumgart\|first2=Leslie H.\|date=2000-01-01\|title=Hilar Cholangiocarcinoma: A Review and Commentary\|url=https://doi.org/10.1007/s10434-000-0055-4\|journal=Annals of Surgical Oncology\|language=en\|volume=7\|issue=1\|pages=55–66\|doi=10.1007/s10434-000-0055-4\|issn=1534-4681}}</ref><ref>{{Cite journal\|last=Washburn\|first=W. Kenneth\|last2=Lewis\|first2=W. David\|last3=Jenkins\|first3=Roger L.\|date=1995-03-01\|title=Aggressive Surgical Resection for Cholangiocarcinoma\|url=https://doi.org/10.1001/archsurg.1995.01430030040006\|journal=Archives of Surgery\|volume=130\|issue=3\|pages=270–276\|doi=10.1001/archsurg.1995.01430030040006\|issn=0004-0010}}</ref><ref>{{Cite journal\|last=Rea\|first=David J.\|last2=Munoz-Juarez\|first2=Manuel\|last3=Farnell\|first3=Michael B.\|last4=Donohue\|first4=John H.\|last5=Que\|first5=Florencia G.\|last6=Crownhart\|first6=Brian\|last7=Larson\|first7=Dirk\|last8=Nagorney\|first8=David M.\|date=2004-05-05\|title=Major Hepatic Resection for Hilar Cholangiocarcinoma: Analysis of 46 Patients\|url=https://doi.org/10.1001/archsurg.139.5.514\|journal=Archives of Surgery\|volume=139\|issue=5\|pages=514–525\|doi=10.1001/archsurg.139.5.514\|issn=0004-0010}}</ref> [[Prognosis]] mungkin lebih buruk bagi pengidap ''[[:en:Primary_sclerosing_cholangitis\|primary sclerosing cholangitis]]'' yang mengembangkan kolangiokarsinoma, kemungkinan karena kanker tidak terdeteksi sampai stadium lanjut.<ref name=":8" /> Beberapa bukti menunjukkan bahwa hasil mungkin membaik dengan pendekatan bedah yang lebih intensif dan [[:en:Adjuvant_therapy\|terapi adjuvan]].<ref>{{Cite journal\|last=~~Nakeeb~~Chen\|first=~~Attila~~Xiuqiong\|last2=~~Tran~~Meng\|first2=~~Khoi Q.~~Fanqiao\|last3=~~Black~~Xiong\|first3=~~Michael J.~~Hua\|last4=~~Erickson~~Zou\|first4=~~Beth A.~~Yanmei\|~~last5~~date=~~Ritch~~2021\|~~first5~~title=~~Paul~~Adjuvant ~~S.\|last6=Quebbeman\|first6=Edward~~Therapy ~~J.\|last7=Wilson\|first7=Stuart~~for ~~D.\|last8=Demeure\|first8=Michael~~Resectable ~~J.\|last9=Rilling\|first9=William~~Biliary ~~S.\|date=2002-10-01\|title=Improved~~Tract ~~survival~~Cancer: inA ~~resected~~Bayesian ~~biliary~~Network ~~malignancies~~Analysis\|url=https://www.~~surgjournal~~frontiersin.~~com~~org/article/~~S0039-6060(02)00133-2~~10.3389/~~abstract~~fonc.2021.600027\|journal=~~Surgery\|language=English~~Frontiers in Oncology\|volume=~~132\|issue=4\|pages=555–564~~11\|doi=10.~~1067~~3389/~~msy~~fonc.~~2002~~2021.~~127555~~600027\|issn=~~0039~~2234-~~6060~~943X\|pmc=PMC7991284\|pmid=~~12407338~~33777744}}</ref> == Epidemiologi == [[Berkas:Liver tumor types in adults by relative incidence.png\|jmpl\|Jenis tumor pada hati yang banyak terjadi pada orang dewasa di Amerika Serikat, dengan kolangiokarsinoma ada pada peringkat atas<ref>{{Cite web\|last=Themes\|first=U. F. O.\|date=2016-12-27\|title=Masses of the Liver\|url=https://basicmedicalkey.com/masses-of-the-liver-2/\|website=Basicmedical Key\|language=en-US\|access-date=2022-02-10}}</ref>]]Kolangiokarsinoma adalah bentuk [[kanker]] yang relatif jarang terjadi. Setiap tahun, sekitar 2.000 hingga 3.000 kasus baru didiagnosis di [[Amerika Serikat]], yang berarti 1-2 kasus per 100.000 orang dilaporkan per tahun.<ref>{{Cite journal\|last=Landis\|first=S. H.\|last2=Murray\|first2=T.\|last3=Bolden\|first3=S.\|last4=Wingo\|first4=P. A.\|date=1998-01-01\|title=Cancer statistics, 1998\|url=https://doi.org/10.3322/canjclin.48.1.6\|journal=CA: A Cancer Journal for Clinicians\|volume=48\|issue=1\|pages=6–29\|doi=10.3322/canjclin.48.1.6\|issn=0007-9235}}</ref> Dalam suatu seri [[otopsi]] telah melaporkan prevalensi 0,01% hingga 0,46%.<ref name=":11">{{Cite journal\|last=Vauthey\|first=Jean-Nicolas\|last2=Blumgart\|first2=Leslie H.\|date=1994-05\|title=Recent Advances in the Management of Cholangiocarcinomas\|url=http://www.thieme-connect.de/DOI/DOI?10.1055/s-2007-1007302\|journal=Seminars in Liver Disease\|language=en\|volume=14\|issue=02\|pages=109–114\|doi=10.1055/s-2007-1007302\|issn=0272-8087\|access-date=2022-04-05\|archive-date=2018-06-07\|archive-url=https://web.archive.org/web/20180607095149/https://www.thieme-connect.de/DOI/DOI?10.1055%2Fs-2007-1007302\|dead-url=yes}}</ref><ref>{{Cite web\|date=2015-04-02\|title=Cancer Statistics - National Cancer Institute\|url=https://www.cancer.gov/about-cancer/understanding/statistics\|website=www.cancer.gov\|language=en\|access-date=2022-02-11}}</ref> Terdapat [[prevalensi]] yang lebih tinggi dari kolangiokarsinoma di [[Asia]], yang telah dikaitkan dengan infestasi [[parasit]] kronis endemik. Insiden kolangiokarsinoma meningkat seiring bertambahnya usia dan penyakit ini sedikit lebih sering terjadi pada pria daripada wanita (dimungkinkan karena tingkat ''[[:en:Primary_sclerosing_cholangitis\|primary sclerosing cholangitis]]'' sebagai faktor risiko utama tingkat kejadianya lebih tinggi pada pria).<ref name=":10" /> Prevalensi dari kolangiokarsinoma pada orang dengan ''[[:en:Primary_sclerosing_cholangitis\|primary sclerosing cholangitis]]'' adalah sebesar 30%, berdasarkan studi otopsi.<ref name=":8" /> Berbagai penelitian telah mendokumentasikan peningkatan yang stabil dalam insiden kolangiokarsinoma intrahepatik. Peningkatan tersebut telah terlihat di [[Amerika Utara]], [[Eropa]], [[Asia]], dan [[Australia]].<ref>{{Cite journal\|last=Patel\|first=Tushar\|date=2002-05-03\|title=Worldwide trends in mortality from biliary tract malignancies\|url=https://doi.org/10.1186/1471-2407-2-10\|journal=BMC Cancer\|volume=2\|issue=1\|pages=10\|doi=10.1186/1471-2407-2-10\|issn=1471-2407\|pmc=PMC113759\|pmid=11991810}}</ref><ref>{{Cite journal\|last=Patel\|first=T\|date=2001-06\|title=Increasing incidence and mortality of primary intrahepatic cholangiocarcinoma in the United States\|url=https://doi.org/10.1053/jhep.2001.25087\|journal=Hepatology\|volume=33\|issue=6\|pages=1353–1357\|doi=10.1053/jhep.2001.25087\|issn=0270-9139}}</ref><ref>{{Cite journal\|last=Shaib\|first=Yasser H.\|last2=Davila\|first2=Jessica A.\|last3=McGlynn\|first3=Kathryn\|last4=El-Serag\|first4=Hashem B.\|date=2004-03-01\|title=Rising incidence of intrahepatic cholangiocarcinoma in the United States: a true increase?\|url=https://www.journal-of-hepatology.eu/article/S0168-8278(03)00627-5/abstract\|journal=Journal of Hepatology\|language=English\|volume=40\|issue=3\|pages=472–477\|doi=10.1016/j.jhep.2003.11.030\|issn=0168-8278}}</ref><ref>{{Cite journal\|last=West\|first=J.\|last2=Wood\|first2=H.\|last3=Logan\|first3=R. F. A.\|last4=Quinn\|first4=M.\|last5=Aithal\|first5=G. P.\|date=2006-06\|title=Trends in the incidence of primary liver and biliary tract cancers in England and Wales 1971–2001\|url=https://www.nature.com/articles/6603127\|journal=British Journal of Cancer\|language=en\|volume=94\|issue=11\|pages=1751–1758\|doi=10.1038/sj.bjc.6603127\|issn=1532-1827\|pmc=PMC2361300\|pmid=16736026}}</ref><ref name=":13">{{Cite journal\|last=Khan\|first=Shahid A.\|last2=Taylor-Robinson\|first2=Simon D.\|last3=Toledano\|first3=Mireille B.\|last4=Beck\|first4=Angus\|last5=Elliott\|first5=Paul\|last6=Thomas\|first6=Howard C.\|date=2002-12-01\|title=Changing international trends in mortality rates for liver, biliary and pancreatic tumours\|url=https://www.journal-of-hepatology.eu/article/S0168-8278(02)00297-0/abstract\|journal=Journal of Hepatology\|language=English\|volume=37\|issue=6\|pages=806–813\|doi=10.1016/S0168-8278(02)00297-0\|issn=0168-8278}}</ref><ref>{{Cite journal\|last=Welzel\|first=Tania M.\|last2=McGlynn\|first2=Katherine A.\|last3=Hsing\|first3=Ann W.\|last4=O'Brien\|first4=Thomas R.\|last5=Pfeiffer\|first5=Ruth M.\|date=2006-06-21\|title=Impact of Classification of Hilar Cholangiocarcinomas (Klatskin Tumors) on the Incidence of Intra- and Extrahepatic Cholangiocarcinoma in the United States\|url=https://doi.org/10.1093/jnci/djj234\|journal=JNCI: Journal of the National Cancer Institute\|volume=98\|issue=12\|pages=873–875\|doi=10.1093/jnci/djj234\|issn=0027-8874}}</ref> Alasan peningkatan terjadinya kolangiokarsinoma belum bisa dijelaskan. Metode diagnostik yang lebih baik mungkin dapat membantu, tetapi prevalensi faktor risiko potensial untuk kolangiokarsinoma, seperti infeksi [[HIV]] juga telah mengalami peningkatan.<ref name=":9" /> {\| class="wikitable" \|+Usia kematian standar dari kolangiokarsinoma intrahepatik (IC) dan ekstrahepatik (EC) untuk pria dan wanita berdasarkan negara<ref name=":13">{{Cite journal\|last=Khan\|first=Shahid A.\|last2=Taylor-Robinson\|first2=Simon D.\|last3=Toledano\|first3=Mireille B.\|last4=Beck\|first4=Angus\|last5=Elliott\|first5=Paul\|last6=Thomas\|first6=Howard C.\|date=2002-12-01\|title=Changing international trends in mortality rates for liver, biliary and pancreatic tumours\|url=https://www.journal-of-hepatology.eu/article/S0168-8278(02)00297-0/abstract\|journal=Journal of Hepatology\|language=English\|volume=37\|issue=6\|pages=806–813\|doi=10.1016/S0168-8278(02)00297-0\|issn=0168-8278}}</ref> !Negara !IC (pria/wanita)