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Baris 4:
| synonyms = Kanker saluran empedu
| image = Cholangiocarcinoma - very high mag.jpg
| caption = Gambar mikroskopokmikroskopik pada kolangiokarsinoma intrahepatik (gambar sebelah kanan) yang berdekatan dengan sel hati normal (gambar sebelah kiri). Noda H&E.
| field = [[Onkologi]]
| pronounce = {{IPAc-en|k|ə|,|l|æ|n|dʒ|i|ou|,|k|a:r|s|I|'|n|ou|m|ə|}} {{respell|kə-LAN-jee-oh-KAR-sih-NOH-mə}}
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'''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 ulserativaulseratif]], 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>
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== Tanda dan gejala ==
[[Berkas:Jaundice of the sclerotic.JPG|jmpl|Menguningnya kulit (''[[Jaundis|jaundice]]'') dan mata (''scleral icterus'').]]
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=NagorneyLlano|first=DavidRodrigo M.|last2=Donohue|first2=John H.|last3=Farnell|first3=Michael B.|last4=Schleck|first4=Cathy D.|last5=Ilstrup|first5=Duane M.Castaño|date=1993-08-012011|title=OutcomesHilar AfterCholangiocarcinoma Curative(Klatskin Resections of Cholangiocarcinomatumor)|url=httpshttp://doiwww.scielo.org/10.1001co/pdf/archsurg.1993rcg/v26n2/en_v26n2a08.01420200045008pdf|journal=ArchivesCol of SurgeryGastroenterol|volume=12826|issue=8|pages=871–878|doi=10.1001/archsurg.1993.01420200045008|issn=0004-00102}}</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 namejournal|last="Roche|first=Sean P.|last2=Kobos|first2=Rebecca|date=2004|title=Jaundice in the Adult Patient|url=https:6"//www.aafp.org/afp/2004/0115/afp20040115p299.pdf|journal=American Family Physician|volume=69|issue=2}}</ref><ref>{{Cite bookjournal|last=FeldmanFargo|first=MarkMatthew V.|last2=FriedmanGrogan|first2=LawrenceScott SP.|last3=BrandtSaguil|first3=Lawrence J.Aaron|date=20062017|title=Evaluation of Jaundice in Adults|url=https://archivewww.aafp.org/detailsafp/sleisengerfordtr0000unse_j1o52017/page0201/1493afp20170201p164.pdf|titlejournal=SleisengerAmerican andFamily Fordtran's Gastrointestinal and Liver Disease (8th ed)Physician|isbnvolume=978-1-4160-0245-195|pages=1493-6|url-statusissue=live3}}</ref>
[[Berkas:Clonorchis sinensis LifeCycle.png|jmpl|Siklus hidup dari ''[[:en:Clonorchis_sinensis|Clonorchis sinensis]]'', [[cacing hati]] yang terkait dengan kolangiokarsinoma]]
 
== Faktor risiko ==
Meskipun kebanyakan pengidap tidak memiliki faktor risiko, sejumlah faktor risiko untuk perkembangan kolangiokarsinoma dapat dideskripsikan. Di negara Barat, faktor risiko yang paling umum adalah ''[[:en:Primary_sclerosing_cholangitis|primary sclerosing cholangitis]]'' (PSC), penyakit radang [[saluran empedu]] yang terkait erat dengan [[:en:Ulcerative_colitis|kolitis ulserativaulseratif]] (UC).<ref>{{Cite journal|last=Chapman|first=R.W.|date=1999|title=Risk factors for biliary tract carcinogenesis|url=https://www.researchgateannalsofoncology.netorg/publicationarticle/S0923-7534(20)31169-8/12862628_Risk_factors_for_biliary_tract_carcinogenesispdf|journal=Annals of Oncology|volume=10|issue=2|doi=DOI: 10.1093/annonc/10.suppl_4.S308}}</ref> Studi [[Epidemiologi|epidemiologis]] menyebutkan bahwa seseorang yang mengidap ''primary sclerosing cholangitis'' (PSC) akan lebih berisiko sebesar 10-15% untuk terkena kolangiokarsinoma.<ref>{{Cite journal|last=Bergquist|first=Annika|last2=Ekbom|first2=Anders|last3=Olsson|first3=Rolf|last4=Kornfeldt|first4=Dan|last5=Lööf|first5=Lars|last6=Danielsson|first6=Åke|last7=Hultcrantz|first7=Rolf|last8=Lindgren|first8=Stefan|last9=Prytz|first9=Hanne|date=2002-03-01|title=Hepatic and extrahepatic malignancies in primary sclerosing cholangitis|url=https://www.journal-of-hepatology.eu/article/S0168-8278(01)00288-4/abstract|journal=Journal of Hepatology|language=English|volume=36|issue=3|pages=321–327|doi=10.1016/S0168-8278(01)00288-4|issn=0168-8278}}</ref><ref>{{Cite journal|last=Bergquist|first=Annika|last2=Glaumann|first2=Hans|last3=Persson|first3=Bo|last4=Broomé|first4=Ulrika|date=1998|title=Risk factors and clinical presentation of hepatobiliary carcinoma in patients with primary sclerosing cholangitis: A case-control study|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/hep.510270201|journal=Hepatology|language=en|volume=27|issue=2|pages=311–316|doi=10.1002/hep.510270201|issn=1527-3350}}</ref><ref>{{Cite journal|last=Burak|first=Kelly|last2=Angulo|first2=Paul|last3=Pasha|first3=Tousif M|last4=Egan|first4=Kathleen|last5=Petz|first5=Jan|last6=Lindor|first6=Keith D|date=2004-03|title=Incidence and Risk Factors for Cholangiocarcinoma in Primary Sclerosing Cholangitis|url=https://sites.ualberta.ca/~loewen/Medicine/GIM%20Residents%20Core%20Reading/CIRRHOSIS,%20ALCOHOL,%20PBC,%20PSC,%20AUTOIMMUNE%20HEP/PSC%20incidence,%20risks.pdf|journal=American Journal of Gastroenterology|volume=99|issue=3|pages=523–526|doi=10.1111/j.1572-0241.2004.04067.x|issn=0002-9270}}</ref> Meskipun, dari suatu seri [[otopsi]] telah menemukan risiko yang lebih tinggi yaitu sebesar 30% pada penderita ''primary sclerosing cholangitis'' (PSC) untuk terkena kolangiokarsinoma.<ref name=":8">{{Cite journal|last=Rosen|first=Charles B.|last2=Nagorney|first2=David M.|last3=Wiesner|first3=Russell H.|last4=Coffey|first4=ROBERT J. Jr|last5=Larusso|first5=Nicholas F.|date=1991-01|title=Cholangiocarcinoma Complicating Primary Sclerosing Cholangitis|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1358305/|journal=Annals of Surgery|language=en-US|volume=213|issue=1|pages=21–25|doi=10.1097/00000658-199101000-00004|issn=0003-4932|pmc=PMC1358305|pmid=1845927}}</ref>
 
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 journalbook|last=RustagiLocke|first=TarunVictoria|last2=DasanuKusnik|first2=ConstantinAlexander|last3=Richardson|first3=Melissa AS.|date=2012-062022-01|title=Risk Factors for Gallbladder Cancer and Cholangiocarcinoma: Similarities, Differences and Updates-09|url=https://doiwww.org/10ncbi.nlm.1007nih.gov/books/NBK532892/s12029-011-9284-y|journaltitle=JournalClonorchis of GastrointestinalSinensis|publisher=StatPearls CancerPublishing|language=en|volumepmid=43|issue=2|pages=137–147|doi=10.1007/s12029-011-9284-y|issn=1941-663630422487}}</ref><ref>{{Cite journal|last=HongKim|first=SungTong-TaeSoo|last2=FangPak|first2=YueyiJhang Ho|last3=Kim|first3=Jong-Bo|last4=Bahk|first4=Young Yil|date=20122016-0311-0130|title=Clonorchis sinensis, an oriental andliver clonorchiasisfluke, anas updatea human biological agent of cholangiocarcinoma: a brief review|url=https://www.sciencedirectncbi.comnlm.nih.gov/sciencepmc/articlearticles/piiPMC5346318/S1383576911000766pdf/bmb-49-590.pdf|journal=ParasitologyBMB International|series=Opisthorchiasis and clonorchiasis: Major neglected tropical diseases in EurasiaReports|language=en|volume=6149|issue=111|pages=17–24590–597|doi=10.10165483/jBMBRep.parint2016.201149.0611.007109|issn=13831976-57696696|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}}</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://journalswww.lwwncbi.comnlm.nih.gov/annalsofsurgerypmc/Abstractarticles/1994PMC1234452/11000pdf/Choledochal_Cyst_Disease_A_Changing_Pattern_of.7annsurg00057-0056.aspxpdf|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=DaytonRahman|first=Merril T.Sabrina|last2=LongmireSayeed|first2=WilliamS P.K Jakaria Been|last3=TompkinsChowdhury|first3=RonaldMostofa K.Kamal|date=19832019-01-01|title=Caroli'sCaroli’s diseaseDisease: A premalignant condition?|url=https://www.americanjournalofsurgerybanglajol.cominfo/index.php/JOM/article/0002-9610(83)90164-2view/abstract38865|journal=The American Journal of Surgery|language=EnglishMedicine|volume=14520|issue=1|pages=41–4855–56|doi=10.10163329/0002-9610(83)90164-2jom.v20i1.38865|issn=00022075-9610|pmid=62951965384}}</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=LeeSu|first=ChengC-ChiH|last2=WuShyr|first2=ChunY-YingM|last3=ChenLui|first3=and GranW-HumY|last4=P'Eng|first4=F-K|date=20021997-0907-01|title=WhatHepatolithiasis isassociated the impact of coexistence of hepatolithiasis onwith cholangiocarcinoma?|url=https://doi.org/10.10461002/j.1440-1746.2002bjs.02779.x1800840717|journal=British Journal of Gastroenterology and HepatologySurgery|volume=1784|issue=97|pages=1015–1020969–973|doi=10.10461002/jbjs.1440-1746.2002.02779.x1800840717|issn=08150007-93191323}}</ref><ref>{{Cite journal|last=SuKim|first=C-H|last2=Shyr|first2=Y-M|last3=Lui|first3=W-Y|last4=P'Eng|first4=F-KHyo Jung|date=1997-07-012015|title=Hepatolithiasis associatedand withintrahepatic cholangiocarcinoma: A review|url=https://doiwww.org/10ncbi.1002nlm.nih.gov/bjspmc/articles/PMC4690170/pdf/WJG-21-13418.1800840717pdf|journal=BritishWorld Journal of SurgeryGastroenterology|language=en|volume=8421|issue=748|pages=969–97313418|doi=10.10023748/bjswjg.1800840717v21.i48.13418|issn=00071007-13239327|pmc=PMC4690170|pmid=26730152}}</ref><ref>{{Cite journal|last=DonatoJiang|first=FrancescoWei|last2=GelattiDeng|first2=UmbertoXiaofei|last3=TaggerZhu|first3=AlessandroTing|last4=FavretWei|first4=MaurizioYuya|last5=RiberoLei|first5=Maria LisaZhen|last6=CalleaGuo|first6=FrancescoMeimei|last7=MartelliYang|first7=Claudia|last8=Savio|first8=Antonella|last9=Trevisi|first9=PaolaJiong|date=20012020-03-12-01|title=IntrahepaticIdentification cholangiocarcinomaof andCholangiocarcinoma hepatitisAssociated Cwith andHepatolithiasis Bvia virusthe infection,Combination alcoholof intake,miRNA and hepatolithiasis: a case–control study in ItalyUltrasound|url=https://doiwww.org/10dovepress.1023com/A:1013747228572identification-of-cholangiocarcinoma-associated-with-hepatolithiasis-v-peer-reviewed-fulltext-article-CMAR|journal=Cancer CausesManagement &and ControlResearch|language=enEnglish|volume=12|issue=10|pages=959–9641845–1853|doi=10.10232147/A:1013747228572CMAR.S241870|issnpmc=1573-7225PMC7075433|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=SahaniLevy|first=D.Dw|last2=PrasadRindsberg|first2=S. R.|last3=TannabeFriedman|first3=K. K.Ac|last4=HahnFishman|first4=P. F.Ek|last5=MuellerRos|first5=P. R.Pr|last6=SainiRadecki|first6=S.Pd|datelast7=2003-01-01Siegelman|titlefirst7=Thorotrast-induced cholangiocarcinoma: case reportSs|urllast8=https://doi.org/10.1007/s00261-001-0148-yGoodman|journalfirst8=Abdominal ImagingZd|languagelast9=enPyatt|volumefirst9=28|issue=1|pages=0072–0074|doi=10.1007/s00261-001-0148-y|issn=1432-0509}}</ref><ref>{{Cite journal|last=Zhu|first=Andrew X.|last2=Lauwers|first2=Gregory Y.|last3=Tanabe|first3=Kenneth K.Rs|date=2004-12-011986|title=CholangiocarcinomaThorotrast-induced inhepatosplenic associationneoplasia: with ThorotrastCT exposureidentification|url=https://doiwww.ajronline.org/doi/pdf/10.10072214/s00534-004-0924-ajr.146.5.997|journal=American Journal of Hepato-Biliary-Pancreatic SurgeryRoentgenology|language=en|volume=11146|issue=65|pages=430–433997–1004|doi=10.10072214/s00534-004-0924-ajr.146.5.997|issn=14360361-0691803X}}</ref><ref>{{Cite journal|last=LipshutzLiu|first=Gerald SDuo|last2=BrennanMomoi|first2=Todd VHirohito|last3=WarrenLi|first3=Robert SLi|last4=Ishikawa|first4=Yuichi|last5=Fukumoto|first5=Manabu|date=2002-1112-01|title=ThorotrastMicrosatellite instability in thorotrast-induced liverhuman neoplasia:intrahepatic A collective reviewcholangiocarcinoma|url=https://doionlinelibrary.orgwiley.com/doi/10.10161002/S1072-7515(02)01287-5ijc.10726|journal=International Journal of the American College of SurgeonsCancer|language=en|volume=195102|issue=54|pages=713–718366–371|doi=10.10161002/s1072-7515(02)01287-5ijc.10726|issn=10720020-75157136}}</ref>▼
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}}</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://journals.lww.com/annalsofsurgery/Abstract/1994/11000/Choledochal_Cyst_Disease_A_Changing_Pattern_of.7.aspx|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=Dayton|first=Merril T.|last2=Longmire|first2=William P.|last3=Tompkins|first3=Ronald K.|date=1983-01-01|title=Caroli's disease: A premalignant condition?|url=https://www.americanjournalofsurgery.com/article/0002-9610(83)90164-2/abstract|journal=The American Journal of Surgery|language=English|volume=145|issue=1|pages=41–48|doi=10.1016/0002-9610(83)90164-2|issn=0002-9610|pmid=6295196}}</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=Lee|first=Cheng-Chi|last2=Wu|first2=Chun-Ying|last3=Chen|first3=and Gran-Hum|date=2002-09|title=What is the impact of coexistence of hepatolithiasis on cholangiocarcinoma?|url=https://doi.org/10.1046/j.1440-1746.2002.02779.x|journal=Journal of Gastroenterology and Hepatology|volume=17|issue=9|pages=1015–1020|doi=10.1046/j.1440-1746.2002.02779.x|issn=0815-9319}}</ref><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=Donato|first=Francesco|last2=Gelatti|first2=Umberto|last3=Tagger|first3=Alessandro|last4=Favret|first4=Maurizio|last5=Ribero|first5=Maria Lisa|last6=Callea|first6=Francesco|last7=Martelli|first7=Claudia|last8=Savio|first8=Antonella|last9=Trevisi|first9=Paola|date=2001-12-01|title=Intrahepatic cholangiocarcinoma and hepatitis C and B virus infection, alcohol intake, and hepatolithiasis: a case–control study in Italy|url=https://doi.org/10.1023/A:1013747228572|journal=Cancer Causes & Control|language=en|volume=12|issue=10|pages=959–964|doi=10.1023/A:1013747228572|issn=1573-7225}}</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=Sahani|first=D.|last2=Prasad|first2=S. R.|last3=Tannabe|first3=K. K.|last4=Hahn|first4=P. F.|last5=Mueller|first5=P. R.|last6=Saini|first6=S.|date=2003-01-01|title=Thorotrast-induced cholangiocarcinoma: case report|url=https://doi.org/10.1007/s00261-001-0148-y|journal=Abdominal Imaging|language=en|volume=28|issue=1|pages=0072–0074|doi=10.1007/s00261-001-0148-y|issn=1432-0509}}</ref><ref>{{Cite journal|last=Zhu|first=Andrew X.|last2=Lauwers|first2=Gregory Y.|last3=Tanabe|first3=Kenneth K.|date=2004-12-01|title=Cholangiocarcinoma in association with Thorotrast exposure|url=https://doi.org/10.1007/s00534-004-0924-5|journal=Journal of Hepato-Biliary-Pancreatic Surgery|language=en|volume=11|issue=6|pages=430–433|doi=10.1007/s00534-004-0924-5|issn=1436-0691}}</ref><ref>{{Cite journal|last=Lipshutz|first=Gerald S|last2=Brennan|first2=Todd V|last3=Warren|first3=Robert S|date=2002-11|title=Thorotrast-induced liver neoplasia: A collective review|url=https://doi.org/10.1016/S1072-7515(02)01287-5|journal=Journal of the American College of Surgeons|volume=195|issue=5|pages=713–718|doi=10.1016/s1072-7515(02)01287-5|issn=1072-7515}}</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=Klatskin|first=Gerald|date=1965-02-01|title=Adenocarcinoma of the hepatic duct at its bifurcation within the porta hepatis: An unusual tumor with distinctive clinical and pathological features|url=https://www.amjmed.com/article/0002-9343(65)90178-6/abstract|journal=The American Journal of Medicine|language=English|volume=38|issue=2|pages=241–256|doi=10.1016/0002-9343(65)90178-6|issn=0002-9343}}</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]] pluripotentpluripoten 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 responrespons 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 kantungkantong empedu dari jaringan jinak pada kantungkantong empedu. Namun, pewarnaan untuk [[:en:Cytokeratin|sitokeratin]], [[antigen karsinoembrionik]], dan [[:en:Mucin|musin]] dapat membantu dalam diagnosis.<ref>{{Cite journal|last=de Groen|first=Piet C.|last2=Gores|first2=Gregory J.|last3=LaRusso|first3=Nicholas F.|last4=Gunderson|first4=Leonard L.|last5=Nagorney|first5=David M.|date=1999-10-28|title=Biliary Tract Cancers|url=https://doi.org/10.1056/NEJM199910283411807|journal=New England Journal of Medicine|volume=341|issue=18|pages=1368–1378|doi=10.1056/NEJM199910283411807|issn=0028-4793|pmid=10536130}}</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>
 
== Diagnosis ==
 
=== Tes darah ===
[[Berkas:Cholangiocarcinoma - high mag.jpg|jmpl|Mikrograf intrahepatik, yaitu di dalam [[hati]], kolangiokarsinoma (gambar 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=Siqueira|first=Eduardo|last2=Schoen|first2=Robert E.|last3=Silverman|first3=William|last4=Martini|first4=John|last5=Rabinovitz|first5=Mordechai|last6=Weissfeld|first6=Joel L.|last7=Elmaagd|first7=Kareem Abu|last8=Madariaga|first8=Juan R.|last9=Slivka|first9=Adam|date=2002-07-01|title=Detecting cholangiocarcinoma in patients with primary sclerosing cholangitis|url=https://www.giejournal.org/article/S0016-5107(02)00005-6/abstract|journal=Gastrointestinal Endoscopy|language=English|volume=56|issue=1|pages=40–47|doi=10.1067/mge.2002.125105|issn=0016-5107}}</ref><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 64 ⟶ 63:
 
=== Pencitraan saluran empedu ===
Meskipun pencitraan abdominal dapat berguna dalam diagnosis kolangiokarsinoma, pencitraan langsung dari [[saluran empedu]] sering kali tetap diperlukan. E''ndoscopic retrograde cholangiopancreatography'' (ERCP), prosedur [[endoskopi]] yang dilakukan oleh gastroenterolog atau dokter bedah yang terlatih khusus, telah banyak dilakukan. Meskipun ERCP adalah prosedur invasif dengan risiko yang menyertainya, keuntungannya adalah mencakup kemampuan untuk mendapatkan [[biopsi]] dan memasang [[:en:Stent|stent]] atau melakukan intervensi lain untuk meredakan obstruksi saluran empedu.<ref name=":6">{{Cite book|last=Feldman|first=Mark|last2=Friedman|first2=Lawrence S.|last3=Brandt|first3=Lawrence J.|date=2006|url=https://archive.org/details/sleisengerfordtr0000unse_j1o5/page/1493|title=Sleisenger and Fordtran's Gastrointestinal and Liver Disease (8th ed)|isbn=978-1-4160-0245-1|pages=1493-6|url-status=live}}</ref> [[Ultrasonografi medis|Ultrasonografi]] endoskopi juga dapat dilakukan pada saat ERCP dan dapat meningkatkan keakuratan biopsi dan menghasilkan informasi tentang invasi dan kelayakan [[kelenjar getah bening]] untuk dapat dibedah atau tidak.<ref>{{Cite journal|last=Sugiyama|first=M.|last2=Hagi|first2=H.|last3=Atomi|first3=Y.|last4=Saito|first4=M.|date=1997-07-01|title=Diagnosis of portal venous invasion by pancreatobiliary carcinoma: value of endoscopic ultrasonography|url=https://doi.org/10.1007/s002619900227|journal=Abdominal Imaging|language=en|volume=22|issue=4|pages=434–438|doi=10.1007/s002619900227|issn=1432-0509}}</ref> Sebagai alternatif untuk ERCP, ''percutaneous transhepatic cholangiography'' (PTC) dapat dilakukan. ''Magnetic resonance cholangiopancreatography'' (MRCP) adalah alternatif noninvasif untuk ERCP.<ref>{{Cite journal|last=Schwartz|first=L H|last2=Coakley|first2=F V|last3=Sun|first3=Y|last4=Blumgart|first4=L H|last5=Fong|first5=Y|last6=Panicek|first6=D M|date=1998-06-01|title=Neoplastic pancreaticobiliary duct obstruction: evaluation with breath-hold MR cholangiopancreatography.|url=https://www.ajronline.org/doi/10.2214/ajr.170.6.9609160|journal=American Journal of Roentgenology|volume=170|issue=6|pages=1491–1495|doi=10.2214/ajr.170.6.9609160|issn=0361-803X}}</ref><ref>{{Cite journal|last=Zidi|first=S. H.|last2=Prat|first2=F.|last3=Guen|first3=O. Le|last4=Rondeau|first4=Y.|last5=Pelletier|first5=G.|date=2000-01-01|title=Performance characteristics of magnetic resonance cholangiography in the staging of malignant hilar strictures|url=https://gut.bmj.com/content/46/1/103|journal=Gut|language=en|volume=46|issue=1|pages=103–106|doi=10.1136/gut.46.1.103|issn=0017-5749|pmc=PMC1727781|pmid=10601064}}</ref><ref>{{Cite journal|last=Lee|first=Moon-Gyu|last2=Park|first2=Kwang Bo|last3=Shin|first3=Yong Moon|last4=Yoon|first4=Hyun Ki|last5=Sung|first5=Kyu Bo|last6=Kim|first6=Myung Hwan|last7=Lee|first7=Sung Gyu|last8=Kang|first8=Eun Mee|date=2003-03-01|title=Preoperative Evaluation of Hilar Cholangiocarcinoma with Contrast-enhanced Three-dimensional Fast Imaging with Steady-state Precession Magnetic Resonance Angiography: Comparison with Intraarterial Digital Subtraction Angiography|url=https://doi.org/10.1007/s00268-002-6701-1|journal=World Journal of Surgery|language=en|volume=27|issue=3|pages=278–283|doi=10.1007/s00268-002-6701-1|issn=1432-2323}}</ref> Terdapat penulis yang menyarankan bahwa MRCP harus menggantikan ERCP dalam diagnosis [[kanker]] [[saluran empedu]] karena dapat lebih akurat menentukan [[tumor]] dan menghindari risiko daripada ERCP.<ref>{{Cite journal|last=Halefoglu|first=Ahmet Mesrur|date=2007|title=Magnetic resonance cholangiopancreatography: A useful tool in the evaluation of pancreatic and biliary disorders|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146812/pdf/WJG-13-2529.pdf|journal=World Journal of Gastroenterology|language=en|volume=13|issue=17|pages=2529|doi=10.3748/wjg.v13.i18.2529|issn=1007-9327|pmc=PMC4146812|pmid=17551999}}</ref>[[Berkas:CT cholangioca-mark.jpg|jmpl|''CT scan'' yang menunjukkan kolangiokarsinoma]]
=== Pembedahan ===
[[Bedah|Eksplorasi bedah]] mungkin diperlukan untuk mendapatkan [[biopsi]] yang sesuai dan untuk menentukan [[:en:Cancer_staging|stadium]] seseorang dengan kolangiokarsinoma secara akurat. [[Laparoskopi]] dapat digunakan untuk tujuan penentuan stadium dan dapat menghindari kebutuhan akan prosedur bedah yang lebih invasif, seperti [[laparotomi]], pada beberapa orang.<ref>{{Cite journal|last=Weber|first=Sharon M.|last2=DeMatteo|first2=Ronald P.|last3=Fong|first3=Yuman|last4=Blumgart|first4=Leslie H.|last5=Jarnagin|first5=William R.|date=2002-03|title=Staging Laparoscopy in Patients With Extrahepatic Biliary Carcinoma: Analysis of 100 Patients|url=https://journals.lww.com/annalsofsurgery/Abstract/2002/03000/Staging_Laparoscopy_in_Patients_With_Extrahepatic.11.aspx|journal=Annals of Surgery|language=en-US|volume=235|issue=3|pages=392–399|doi=10.1097/00000658-200203000-00011|issn=0003-4932|pmc=PMC1422445|pmid=11882761}}</ref>
Baris 91 ⟶ 90:
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 panduan 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-fluorouracilFluorourasil|5-fluorouracilfluorourasil]] 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|gemcitabinegemsitabin]] 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 gemcitabinegemsitabin 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" />
 
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" />
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