Klatskin Tumor

'''Klatskin tumor is malignant cholangiocarcinoma arising from extrahepatic bile duct near the confluence of left and right hepatic ducts. It is hilar carcinoma. '''

Clinical features
Symptomes are very similar to pancreatic head cancer:
 * painless obstructive jaundice, possible Couvoisier’s sign;
 * abdominal pain
 * weight loss.

Diagnostic methods

 * lab: higher bilirubin, tumormarker CA 19-9 (but is not specific, can be found in patients with colon cancer, pancreatic cancer or biliary obstruction);
 * USG: possible biliary duct dilatation, gallbladder dilatation;
 * EUSG: through the wall of the stomach or duodenum is possible find the tumor;
 * MRCP: is prefered more than ERCP, because MRCP is noninvasive methode which can show stage of tumor process;
 * ERCP (endoscopic retrograde cholangio-pancreatography) should be prefered only if there is no MRCP examination possible or is neccesary therapeutic intervention of biliary obstruction (stent);
 * CT: computer tomography is always neccesary in staging, results of CT will decide about the therapy, should be always performed before ERCP!

TNM Classification

 * Tis – carcinoma in situ;
 * T1 – tumor is in muscular layer of biliar duct;
 * T2a – tumor penetrates to lipid tissue;
 * T2b – tumor petetrates to liver parenchym;
 * T3 – tumor penetrates to left or right portal vein or left or right hepatic artery;
 * T4 – tumor penetrates to portal vein, or left and right portal vein, or common hepatic artery, ...

Bismuth Classification
is based on tomor’s localization in extrahapatic biliary tree:
 * Bismuth I – tumor of common hepatic duct, not reaching the junction;
 * Bismuth II – tumor of common hepatic duct, reaching the junction;
 * Bismuth III – tumor of common hepatic duct and left or right hepatic duct;
 * Bismuth IV – tumor of common hepatic duct and left ahd right hepatic duct.