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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 ulserativa, 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" />
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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=Nagorney|first=David M.|last2=Donohue|first2=John H.|last3=Farnell|first3=Michael B.|last4=Schleck|first4=Cathy D.|last5=Ilstrup|first5=Duane M.|date=1993-08-01|title=Outcomes After Curative Resections of Cholangiocarcinoma|url=https://doi.org/10.1001/archsurg.1993.01420200045008|journal=Archives of Surgery|volume=128|issue=8|pages=871–878|doi=10.1001/archsurg.1993.01420200045008|issn=0004-0010}}</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 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>
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== 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 ulserativa]] (UC).<ref>{{Cite journal|last=Chapman|first=R.W.|date=1999|title=Risk factors for biliary tract carcinogenesis|url=https://www.researchgate.net/publication/12862628_Risk_factors_for_biliary_tract_carcinogenesis|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?id=10.1371/journal.pmed.0040201|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 journal|last=Rustagi|first=Tarun|last2=Dasanu|first2=Constantin A.|date=2012-06-01|title=Risk Factors for Gallbladder Cancer and Cholangiocarcinoma: Similarities, Differences and Updates|url=https://doi.org/10.1007/s12029-011-9284-y|journal=Journal of Gastrointestinal Cancer|language=en|volume=43|issue=2|pages=137–147|doi=10.1007/s12029-011-9284-y|issn=1941-6636}}</ref><ref>{{Cite journal|last=Hong|first=Sung-Tae|last2=Fang|first2=Yueyi|date=2012-03-01|title=Clonorchis sinensis and clonorchiasis, an update|url=https://www.sciencedirect.com/science/article/pii/S1383576911000766|journal=Parasitology International|series=Opisthorchiasis and clonorchiasis: Major neglected tropical diseases in Eurasia|language=en|volume=61|issue=1|pages=17–24|doi=10.1016/j.parint.2011.06.007|issn=1383-5769}}</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>
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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]] pluripotent 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 respon 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 kantung empedu dari jaringan jinak pada kantung 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 ==
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== Pengobatan ==
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.lww.com/annalsofsurgery/Abstract/1996/04000/Factors_Influencing_Postoperative_Morbidity,.7.aspx|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> 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.lww.com/co-gastroenterology/Abstract/2013/05000/Locoregional_therapy_for_cholangiocarcinoma.15.aspx|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]] 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
[[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>]]
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.[[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>]]
 
=== 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" />
 
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|first=David R.|last2=Weaver|first2=Amy L.|last3=Nagorney|first3=David M.|date=1995-05-01|title=“Natural History” of Unresected Cholangiocarcinoma: Patient Outcome After Noncurative Intervention|url=https://www.mayoclinicproceedings.org/article/S0025-6196(11)63877-9/abstract|journal=Mayo Clinic Proceedings|language=English|volume=70|issue=5|pages=425–429|doi=10.4065/70.5.425|issn=0025-6196}}</ref> Durasi rata-rata kelangsungan hidup keseluruhan kurang dari 6 bulan pada penderita yang tumornya sudah bermetastasis.<ref>{{Cite journal|last=Grove|first=Mark K.|last2=Hermann|first2=Robert E.|last3=Vogt|first3=David P.|last4=Broughan|first4=Thomas A.|date=1991-04-01|title=Role of radiation after operative palliation in cancer of the proximal bile ducts|url=https://www.americanjournalofsurgery.com/article/0002-9610(91)91111-U/abstract|journal=The American Journal of Surgery|language=English|volume=161|issue=4|pages=454–458|doi=10.1016/0002-9610(91)91111-U|issn=0002-9610|pmid=1709795}}</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.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=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.lww.com/annalsofsurgery/Abstract/2005/01000/Actual_Long_term_Outcome_of_Extrahepatic_Bile_Duct.11.aspx|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|first=Mark J.|last2=Barry|first2=M. Kevin|last3=Rowland|first3=Charles|last4=Ilstrup|first4=Duane M.|last5=Nagorney|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.|last6=Belghiti|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=Fumihiko|last7=Ochiai|first7=Takenori|date=2003-03-01|title=Aggressive Surgical Resection for Hilar-invasive and Peripheral Intrahepatic Cholangiocarcinoma|url=https://doi.org/10.1007/s00268-002-6696-7|journal=World Journal of Surgery|language=en|volume=27|issue=3|pages=289–293|doi=10.1007/s00268-002-6696-7|issn=1432-2323}}</ref><ref>{{Cite journal|last=Weber|first=S|date=2001-10|title=Intrahepatic Cholangiocarcinoma: resectability, recurrence pattern, and outcomes|url=https://doi.org/10.1016/S1072-7515(01)01016-X|journal=Journal of the American College of Surgeons|volume=193|issue=4|pages=384–391|doi=10.1016/s1072-7515(01)01016-x|issn=1072-7515}}</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.lww.com/annalsofsurgery/Abstract/1998/09000/Hilar_Cholangiocarcinoma__Patterns_of_Spread,_the.11.aspx|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 terapi adjuvan.<ref>{{Cite journal|last=Nakeeb|first=Attila|last2=Tran|first2=Khoi Q.|last3=Black|first3=Michael J.|last4=Erickson|first4=Beth A.|last5=Ritch|first5=Paul S.|last6=Quebbeman|first6=Edward J.|last7=Wilson|first7=Stuart D.|last8=Demeure|first8=Michael J.|last9=Rilling|first9=William S.|date=2002-10-01|title=Improved survival in resected biliary malignancies|url=https://www.surgjournal.com/article/S0039-6060(02)00133-2/abstract|journal=Surgery|language=English|volume=132|issue=4|pages=555–564|doi=10.1067/msy.2002.127555|issn=0039-6060|pmid=12407338}}</ref>
 
== Epidemiologi ==
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" />
{| class="wikitable"
|+Usia kematian standar dari kolangiokarsinoma intrahepatik (IC) dan ekstrahepatik (EC) untuk pria dan wanita berdasarkan negara<ref name=":13" />
!Negara
!IC (pria/wanita)
!EC (pria/wanita)
|-
!'''Amerika Serikat'''
|0,60/0,43
|0,70/0,87
|-
!Jepang
|0.23/0,10
|5,87/5,20
|-
!'''Australia'''
|0,70/0,53
|0,90/1,23
|-
!'''Inggris'''
|0,83/0,63
|0,43/0,60
|-
!'''Skotlandia'''
|1,17/1,00
|0,60/0,73
|-
!'''Prancis'''
|0.27/0.20
|1,20/1,37
|-
!'''Italia'''
|0,13/0,13
|2,10/2,60
|}
 
== Referensi ==
<references />
[[Berkas:ERCP cholangioca.jpg|jmpl|Gambar ERCP dari kolangiokarsinoma, menunjukkan penyempitan saluran empedu dan pelebaran saluran empedu proksimal]]
 
== Prana luar ==
 
Diperoleh dari "https://wiki-indonesia.club/wiki/Kolangiokarsinoma"