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The diagnosis and treatment of cholangiocarcinoma.
[cholangiocarcinoma]
Cholangiocarcinoma
(
CCA
)
is
the
second
most
common
primary
hepatic
tumor
in
Germany
,
with
about
3500
new
cases
per
year
.
In
recent
years
,
its
prognosis
has
improved
because
of
wider
resections
and
the
establishment
of
local
treatment
and
chemotherapy
in
the
palliative
situation
.
This
review
is
based
on
pertinent
articles
that
were
retrieved
by
a
selective
literature
search
in
the
PubMed
database
with
the
keywords
"
cholangiocarcinoma
AND
diagnostic
OR
therapy
.
"
Articles
in
English
or
German
published
up
to
January
2014
were
considered
.
The
sole
curative
treatment
for
CCA
is
surgery
,
but
40
-
85
%
of
all
patients
have
recurrent
disease
even
after
radical
excision
.
Because
of
this
high
recurrence
rate
,
adjuvant
treatments
are
now
under
intense
discussion
.
For
unresectable
CCA
without
distant
metastases
,
small
case
series
have
shown
that
liver
transplantation
can
yield
promising
survival
rates
of
over
50
%
at
5
years
.
For
many
patients
with
CCA
,
however
,
only
palliative
treatments
can
be
offered
,
including
endoscopic
clearing
of
the
biliary
pathways
.
Because
of
the
low
prevalence
of
the
disease
,
there
have
been
only
a
few
phase
3
studies
of
palliative
chemotherapy
for
CCA
.
On
the
basis
of
one
positive
phase
3
study
,
chemotherapy
with
gemcitabine
and
cisplatin
is
considered
the
standard
and
now
plays
an
established
role
in
palliative
care
.
CCA
presents
a
special
challenge
in
gastroenterology
,
oncology
,
and
visceral
surgery
because
of
the
difficulty
in
establishing
the
diagnosis
,
local
complications
in
the
biliary
pathways
,
and
a
high
recurrence
rate
after
resection
.
Future
studies
should
address
not
only
the
role
of
adjuvant
chemotherapy
,
but
also
the
efficacy
of
combined
local
and
systemic
treatment
.
Diseases
Validation
Diseases presenting
"there have been only a few phase 3 studies of palliative chemotherapy for cca"
symptom
cholangiocarcinoma
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