Kolangiokarsinoma: Perbedaan antara revisi
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=== Kemoterapi adjuvan dan terapi radiasi ===
Jika [[tumor]] dapat diangkat melalui [[pembedahan]], penderita akan menerima [[kemoterapi]] adjuvan atau [[terapi radiasi]] setelah operasi untuk meningkatkan kemungkinan penyembuhan. Jika margin jaringan negatif (yaitu tumor telah dieksisi total), terapi ajuvan tidak dapat dipasti manfaatnya. Hasil positif<ref>{{Cite journal|last=Todoroki|first=Takeshi|last2=Ohara|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|date=2000-02-01|title=Benefits of adjuvant radiotherapy after radical resection of locally advanced main hepatic duct carcinoma|url=https://www.redjournal.org/article/S0360-3016(99)00472-1/abstract|journal=International Journal of Radiation Oncology, Biology, Physics|language=English|volume=46|issue=3|pages=581–587|doi=10.1016/S0360-3016(99)00472-1|issn=0360-3016|pmid=10701737}}</ref><ref>{{Cite journal|last=Alden|first=Mark E.|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.redjournal.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=8138448}}</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.lww.com/annalsofsurgery/Abstract/1995/06000/Perihilar_Cholangiocarcinoma_Postoperative.17.aspx|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|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}}</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 rejimen kemoterapi tunggal yang digunakan secara universal, dan pendaftaran dalam uji klinis sering direkomendasikan bila memungkinkan. Agen kemoterapi yang digunakan untuk mengobati kolangiokarsinoma termasuk [[:en:5-fluorouracil|5-fluorouracil]] dengan [[:en:Leucovorin|leucovorin]],<ref>{{Cite journal|last=Choi|first=Chul Won|last2=Choi|first2=Keun|last3=Seo|first3=Jae Hong|last4=Kim|first4=Byung Soo|last5=Kim|first5=Jae Seon|last6=Kim|first6=Chang Duk|last7=Um|first7=Soon Ho|last8=Kim|first8=Jun Suk|last9=Kim|first9=Yeul Hong|date=2000-08|title=Effects of 5-Fluorouracil and Leucovorin in the Treatment of Pancreatic–Biliary Tract Adenocarcinomas|url=https://journals.lww.com/amjclinicaloncology/Abstract/2000/08000/Effects_of_5_Fluorouracil_and_Leucovorin_in_the.23.aspx|journal=American Journal of Clinical Oncology|language=en-US|volume=23|issue=4|pages=425–428|doi=10.1097/00000421-200008000-00023|issn=0277-3732}}</ref> [[:en:Gemcitabine|gemcitabine]] 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 gemcitabine 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|first=Pankaj|last2=Jani|first2=Chirag R.|last3=Savarese|first3=Diane M. F.|last4=O’donnell|first4=Judith L.|last5=Stuart|first5=Keith E.|last6=Lima|first6=Caio Max S. Rocha|date=2003|title=Gemcitabine and Irinotecan in Locally Advanced or Metastatic Biliary Cancer: Preliminary Report|url=https://www.cancernetwork.com/view/gemcitabine-and-irinotecan-locally-advanced-or-metastatic-biliary-cancer-preliminary-report|journal=Oncology|volume=17|issue=9}}</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.com/article/S0305-7372(11)00080-6/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" />
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== 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" /><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 kejadinnya 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" />
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