Onkológia 6/2019
Endoscopy in diagnosis and treatment of some malignant tumours
Tumours of liver can be divided into two groups: benign and malignant. The group of benign tumors includes hemangioma, adenoma and focal nodular hyperplasia. Malignant tumours of liver are most frequently represented by secondary tumours – metastases, predominantly originating in digestive tract. The primary malignant tumours are: hepatocelular carcinoma that usually originated from cirrhotic liver and cholangiocarcinoma. Depending on their localization, they can be divided into intrahepatic, perihilar and distal. Perihilar cholangiocarcinomas represent more than 50% of all cholangiocarcinomas. Their clinical manifestations include: painless jaundice associated by generalized malaise, anorexia and weight loss. Diagnosis is based mostly on imaging methods (USG, CT, MRI MRCP, ERCP, PTC and EUS) but also on cytology and histology of the tissue samples. It is very important to distinguish benign strictures (e.g. postsurgical, PSC) from the malignant ones. After diagnosis was established, it is important to decide whether the tumour is operable (resectable) or not. Operable tumors are treated surgically, however in many cases surgery is not possible because of the extent of the tumour. In patients with jaundice, pre-operative drainage is not recommended in most of the cases, because the surgical results are worse in the patients who have a drain than those who don‘t have it. The basis therapy in patients with inoperable tumours is (beside chemotherapy) drainage of the billiary tract – either via transpapillary route (ERCP) or via percutaneous transhepatic approach PTD).
Keywords: tumours of liver, cholangiocarcinoma, perihilar cholangiocarcinoma, surgical treatment, drainage of biliary tract
