Abstract
Cancers of the biliary tract include intra- and extrahepatic cholangiocarcinomas and gallbladder cancer. Biliary tract cancers are diseases with unfavorable prognoses. In recent years, several lesions have been described as precursors that precede biliary cancers. They include flat and microscopic lesions known as biliary intraepithelial neoplasia, macroscopic and tumor-forming intraductal papillary biliary neoplasia, intraductal tubular neoplasia, and mucinous cystic neoplasm of the bile duct. These conditions are rarely diagnosed, while their natural history and progression to cancer have yet to be adequately characterized. This review examines the epidemiology, pathology, molecular biology, diagnosis, and therapy of these various precursors. Further research is required if we are to better understand this evolving field and improve the prevention and early detection of bile duct cancer.
Highlights
The biliary tree consists of extrahepatic biliary ducts that enter the duodenum in the ampulla, extending proximally into intrahepatic biliary ducts
Representing the second most common hepatobiliary malignancy, biliary tract cancers are classified based on location: intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma, and gallbladder carcinoma
The 5-year survival of resected malignant mucinous cystic neoplasm (MCN) is 65-70%, which is better than that reported for hepatocellular carcinoma, cholangiocarcinoma, and intraductal papillary tumors [42]
Summary
The biliary tree consists of extrahepatic biliary ducts that enter the duodenum in the ampulla, extending proximally into intrahepatic biliary ducts. Representing the second most common hepatobiliary malignancy, biliary tract cancers are classified based on location: intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma (perihilar and distal), and gallbladder carcinoma. Of these cancers, gallbladder cancer is the most commonly observed. In the pancreas, the following conditions are acknowledged as precursors of cancer: pancreatic intraepithelial neoplasia (PanIN), intraductal papillary mucinous neoplasia, and mucinous cystic neoplasia The latter two, which can be identified using imaging methods, are currently the subject of extensive research, with recommendations being formulated for successful management [10, 11]. All three precursors have counterparts in the biliary tract [1]
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