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Cholangiocarcinoma

Clinical Description: Cholangiocarcinoma

Similar to gallbladder cancer, the cancer of the bile ducts, called cholangiocarcinoma, is a rare entity accounting for only 3% of gastrointestinal cancer cases and 2 in 100,000 people in the United States. Choangiocarcinomas usually become symptomatic when they obstruct the biliary drainage system, causing painless jaundice.

Symptoms of Cholangiocarcinoma Cancer

Other symptoms include: pruritus (itching), abdominal pain, fever and weight loss. Unfortunately, symptoms usually arise late in the disease and patients present with advanced cancer at diagnosis.

Risk Factors of Cholangiocarcinoma Cancer

Primary sclerosing cholangitis, Lynch syndrome, infection with certain parasites and having chronic liver disease, are some of the risk factors associated with Cholangiocarcinoma.

How Cholangiocarcinoma Cancer is Diagnosed

The initial evaluation will include a physical exam, laboratory and radiological studies. Laboratory studies will suggest a blockage of the biliary system, having increased levels of alkaline phosphatase and direct bilirubin. Tumor markers such as CEA and CA 19-9 can also be increased and help in the diagnosis, but they are not specific for bile duct cancers. To attain the diagnosis, imaging studies and a biopsy should be performed since benign conditions and other types of malignancy can present similarly.

Evaluation includes abdominal ultrasound, CT scan, magnetic resonance cholangiography (MRCP), or endoscopic retrograde cholangiopancreatography (ERCP). These tests help doctors localize the extent of the disease. Biopsy can be obtained either by ERCP, through the skin (percutaneous) guided through a CT scan or surgically as a last approach.

Treatment Options for Cholangiocarcinoma at Tufts Medical Center

Once the diagnosis is confirmed, surgical resection gives the only chance of cure, but treatment with a combination of chemotherapy and/or radiation therapy can also help control the disease. Surgery would involve removal of part of the bile duct and possibly removal of part of the liver. Chemotherapy agents such as gemcitabine, cisplatin, 5-fluorouracil and erlotinib may be useful. Novel treatment approaches are being used. Palliative measures such as endoscopic stents to relieve biliary obstruction can help with symptom control.

Doctors + Care Team

Roger Graham, MD

Roger Graham, MD

Title(s): Chief, Division of General Surgery; Chief, Surgical Oncology; Director, Breast Health Center; Surgeon; Associate Professor, Tufts University School of Medicine
Department(s): Surgery, General Surgery, Surgical Oncology
Appt. Phone: 617-636-8270
Fax #: 617-636-9095

General surgery, surgical oncology, thyroid surgery, breast cancer

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Joel V. Weinstock, MD

Joel V. Weinstock, MD

Title(s): Chief, Division of Gastroenterology/Hepatology; Professor, Tufts University School of Medicine
Department(s): Medicine, Gastroenterology
Appt. Phone: 617-636-5883
Fax #: 617-636-4505

Gastroenterology, inflammatory bowel diseases, mucosal immunity, general gastroenterology, GI bleeding, endoscopy

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E. Kent Yucel, MD

E. Kent Yucel, MD

Title(s): Radiologist-in-Chief; Ettinger–Dreyfus Chair and Professor of Radiology, Tufts University School of Medicine
Department(s): Radiology, CardioVascular Center
Appt. Phone: 617-636-0040
Fax #: 617-636-0041

Interventional radiology, ultrasound, cardiovascular CT and MRI, general radiology

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Andrew G. Plaut, MD
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Andrew G. Plaut, MD

Title(s): Gastroenterologist; Professor, Tufts University School of Medicine
Department(s): Medicine, Gastroenterology
Appt. Phone: 617-636-5883
Fax #: 617-636-4207

Gastroenterology, digestive diseases, gastrointestinal infections and parasitic disease, inflammatory bowel disease, diagnostic evaluation of unexplained pain or diarrhea

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Barbara J. Weinstein, MD

Barbara J. Weinstein, MD

Title(s): Surgical Pathologist; Cytopathologist; Assistant Professor, Tufts University School of Medicine
Department(s): Pathology and Laboratory Medicine
Appt. Phone: 617-636-5829
Fax #: 617-636-8302

General surgical pathology, cytopathology, gastrointestinal pathology

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Gary M. Strauss, MD, MPH

Gary M. Strauss, MD, MPH

Title(s): Medical Director, Lung Cancer Program; Professor, Tufts University School of Medicine
Department(s): Medicine, Hematology/Oncology
Appt. Phone: 617-636-6227
Fax #: 617-636-8538

Lung cancer, melanoma, breast cancer, genitourinary cancer, solid tumors

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Harmony Allison, MD
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Harmony Allison, MD

Title(s): Gastroenterologist; Clinical and Research Instructor, Tufts University School of Medicine
Department(s): Medicine, Gastroenterology
Appt. Phone: 617-636-5883
Fax #: 617-636-1480

Gastrointestinal motility, inflammatory bowel disease, general GI and endoscopy, diarrhea, constipation, celiac sprue and limited LFT abnormalities

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Hoon Ji, MD, PhD

Hoon Ji, MD, PhD

Title(s): Chief of Body MRI; Assistant Professor, Tufts University School of Medicine
Department(s): Radiology
Appt. Phone: 617-636-0040
Fax #: 617-636-0041

Body MRI, general radiology

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Kathleen Viveiros, MD
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Kathleen Viveiros, MD

Title(s): Director, Hematology; Director, Gastroenterology/Hepatology Fellowship Program
Department(s): Medicine, Gastroenterology
Appt. Phone: 617-636-5883
Fax #: 617-636-4207

Hepatology, pre- and postliver transplant, hepatitis, chronic liver disease, general gastroenterology

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Kathryn Huber, MD, PhD

Kathryn Huber, MD, PhD

Title(s): Radiation Oncologist; Assistant Professor, Tufts University School of Medicine
Department(s): Radiation Oncology
Appt. Phone: 617-636-6161
Fax #: 617-636-6131

Radiotherapy for cancers of the lung, gastrointestinal tract, breast and head and neck

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Kevin Daly, MD

Kevin Daly, MD

Title(s): Interventional Radiologist, Cardiovascular and Interventional Radiology; Assistant Professor, Tufts University School of Medicine
Department(s): Radiology, CardioVascular Center
Appt. Phone: 617-636-3004
Fax #: 617-636-1149

Diagnostic and interventional radiology, general radiology

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Laurence H. Brinckerhoff, MD

Laurence H. Brinckerhoff, MD

Title(s): Chief, Thoracic Surgery; Surgeon; Associate Professor, Tufts University School of Medicine
Department(s): Surgery, General Surgery, Thoracic Surgery
Appt. Phone: 617-636-5589
Fax #: 617-636-9095

Thoracic surgical oncology, minimally invasive surgery, clinical trials, tumor immunology

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Lori B. Olans, MD, MPH
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Lori B. Olans, MD, MPH

Title(s): Gastroenterologist; Assistant Professor, Tufts University School of Medicine
Department(s): Medicine, Gastroenterology
Appt. Phone: 617-636-5883
Fax #: 617-636-8615

General gastroenterology, inflammatory bowel disease

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Martin D. Goodman, MD

Martin D. Goodman, MD

Title(s): Surgeon; Director, Peritoneal Surface Malignancy Program; Assistant Professor, Tufts University School of Medicine
Department(s): Surgery, General Surgery, Surgical Oncology
Appt. Phone: 617-636-9248
Fax #: 617-636-9095

General surgery, advanced abdominal tumors, peritoneal surface malignancies, hepatobiliary/pancreatic/colorectal minimally invasive surgical oncology

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Moises Guelrud, MD

Moises Guelrud, MD

Title(s): Gastroenterologist; Professor, Tufts University School of Medicine
Department(s): Medicine, Gastroenterology
Appt. Phone: 617-636-5883
Fax #: 617-636-4505

Gastroenterology, sphincter of Oddi manometry in children and adults, ERCP (diagnosis and therapeutic) in children and adults, ECRP (diagnosis and therapeutic) in children and adults, endoscopic diagnosis and treatment of Barrett's esophagus, magnification endoscopy and chromoendoscopy, pancreatic diseases, endoscopic mucosal resection

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Nayer Nikpoor, MD

Nayer Nikpoor, MD

Title(s): Chief of Nuclear Medicine; Assistant Professor, Tufts University School of Medicine
Department(s): Radiology
Appt. Phone: 617-636-0040
Fax #: 617-636-0041

Nuclear medicine

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Neil J. Halin, DO, FSIR, FAOCR

Neil J. Halin, DO, FSIR, FAOCR

Title(s): Chief, Cardiovascular-Interventional Radiology; Associate Radiologist in Chief; Vice Chair, Radiology for Quality and Operations; Assistant Professor, Tufts University School of Medicine
Department(s): Radiology, CardioVascular Center
Appt. Phone: 617-636-3004
Fax #: 617-636-0041

Peripheral vascular disease, biliary and urinary obstruction, thrombo-embolic disease, vascular disease, general radiology

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Robert Martell, MD, PhD

Robert Martell, MD, PhD

Title(s): Medical Oncologist; Associate Professor, Tufts University School of Medicine
Department(s): Medicine, Hematology/Oncology
Appt. Phone: 617-636-6227
Fax #: 617-636-8538

Phase I clinical trials, GI oncology, breast cancer, head and neck malignancies, liver tumors

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Wasif M. Saif, MD

Wasif M. Saif, MD

Title(s): Director, GI Oncology Program; Leader, Experimental Therapeutics; Professor, Tufts University School of Medicine
Department(s): Medicine, Hematology/Oncology
Appt. Phone: 617-636-6227
Fax #: 617-636-8538

Chemistry and pharmacology of folate antagonist, experimental therapeutics, clinical trial design (Phase I and II), cancers treated include pancreas, gall bladder, cholangiocarcinoma (bile duct), anal, colon (including Rectum), neuroendocrine (carcinoid), psedomyxoma peritonei, esophagus, gastroesophageal (including Stomach), liver, unknown primary, GIST, adrenal, peritoneum, phase I clinical studies of novel cancer drugs and/or combinations

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