A Klatskin tumor, also known as Hilar Cholangiocarcinoma, is a cholangiocarcinoma (cancer of the biliary tree) occurring at the confluence of the right and left hepatic bile ducts.
Bile duct cancer of the upper part of the bile duct is also called Klatskin’s tumor. Klatskin’s tumors involve the upper part of the bile duct as divides to enter the right and the left parts of the liver. The bile ducts in the liver are called right and left hepatic ducts. The tumor may involve one or both right and left sides of the hepatic ducts as they enter the liver. The hepatic ducts are closely associated with the blood vessels that supply blood to the liver. Klatskin’s tumors are closely associated with liver and as they grow invasion into the blood vessels that supply blood to the liver is often found.
Diagnosis and staging of Klatskin’s tumors
The patient usually presents with jaundice (yellowness of the skin) and/or abnormal liver tests. The diagnosis is usually made when the medical work up for the jaundice shows the presence of a tumor in the bile duct. The diagnosis is made by an ERCP or a PTC. These procedures also allow placement of stent to relieve the jaundice. A CT scan is then obtained to stage the tumor.Once diagnosis of a Klatskin’s tumor is made then the goal of the work up is to assess for possible removal of the tumor by surgery.
The liver is made up of two lobes: a right lobe and a left lobe. One of the two lobes can be safely removed at surgery. Klatskin’s tumors often invade the blood vessels called hepatic artery and the portal vein, that supply blood flow to the liver. The goal of staging prior to surgery is to assess whether the blood vessels of the liver are free of the tumor. The location of proximal bile duct tumors sometimes makes this evaluation difficult and often the final decision regarding surgery is made at the time of exploratory surgery.
Treatment and prognosis
Because of their location these tumors present late and therefore are usually not resectable at the time of presentation. Complete resection of the tumor offers hope of long term survival and of late there has been renewed interest in liver transplantation from deceased donors along with adjuvant therapy. Prognosis remains poor today.