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Primary Sclerosing Cholangitis as a Premalignant Biliary Tract Disease: Surveillance and Management

Rizvi, Sumera ; Eaton, John E ; Gores, Gregory J

Clinical gastroenterology and hepatology, 2015-11, Vol.13 (12), p.2152-2165 [Periódico revisado por pares]

United States: Elsevier Inc

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Título:
Primary Sclerosing Cholangitis as a Premalignant Biliary Tract Disease: Surveillance and Management
Autor: Rizvi, Sumera ; Eaton, John E ; Gores, Gregory J
Assuntos: Biliary Dysplasia ; Biliary Tract Neoplasms - diagnosis ; Biliary Tract Neoplasms - epidemiology ; Biliary Tract Neoplasms - prevention & control ; Biliary Tract Neoplasms - therapy ; Chemoprevention ; Chemoradiotherapy, Adjuvant ; Cholangiocarcinoma - diagnosis ; Cholangiocarcinoma - epidemiology ; Cholangiocarcinoma - prevention & control ; Cholangiocarcinoma - therapy ; Cholangitis, Sclerosing - complications ; Cholangitis, Sclerosing - diagnosis ; Cholangitis, Sclerosing - epidemiology ; Cholangitis, Sclerosing - therapy ; Diagnostic Tests, Routine - methods ; Epidemiological Monitoring ; Gastroenterology and Hepatology ; Humans ; Interleukin-6 ; Liver Transplantation ; Perihilar Cholangiocarcinoma
É parte de: Clinical gastroenterology and hepatology, 2015-11, Vol.13 (12), p.2152-2165
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-3
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ObjectType-Review-2
Descrição: Primary sclerosing cholangitis (PSC) is a premalignant biliary tract disease that confers a significant risk for the development of cholangiocarcinoma (CCA). The chronic biliary tract inflammation of PSC promotes pro-oncogenic processes such as cellular proliferation, induction of DNA damage, alterations of the extracellular matrix, and cholestasis. The diagnosis of malignancy in PSC can be challenging because inflammation-related changes in PSC may produce dominant biliary tract strictures mimicking CCA. Biomarkers such as detection of methylated genes in biliary specimens represent noninvasive techniques that may discriminate malignant biliary ductal changes from PSC strictures. However, conventional cytology and advanced cytologic techniques such as fluorescence in situ hybridization for polysomy remain the practice standard for diagnosing CCA in PSC. Curative treatment options of malignancy arising in PSC are limited. For a subset of patients selected by using stringent criteria, liver transplantation after neoadjuvant chemoradiation is a potential curative therapy. However, most patients have advanced malignancy at the time of diagnosis. Advances directed at identifying high-risk patients, early cancer detection, and development of chemopreventive strategies will be essential to better manage the cancer risk in this premalignant disease. A better understanding of dysplasia definition and especially its natural history is also needed in this disease. Herein, we review recent developments in our understanding of the risk factors, pathogenic mechanisms of PSC associated with CCA, as well as advances in early detection and therapies.
Editor: United States: Elsevier Inc
Idioma: Inglês

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Primary Sclerosing Cholangitis as a Premalignant Biliary Tract Disease: Surveillance and Management

Rizvi, Sumera ; Eaton, John E ; Gores, Gregory J

United States: Elsevier Inc

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