{"id":8683,"date":"2015-05-26T17:47:23","date_gmt":"2015-05-26T15:47:23","guid":{"rendered":"https:\/\/dev.93-93-113-41.plesk.page\/?page_id=8683"},"modified":"2024-02-26T17:11:44","modified_gmt":"2024-02-26T16:11:44","slug":"colangiocarcinoma","status":"publish","type":"page","link":"https:\/\/dev.93-93-113-41.plesk.page\/ca\/serveis\/aparell-digestiu\/pancrees-i-vies-biliars\/cancer-de-via-biliar\/colangiocarcinoma\/","title":{"rendered":"Colangiocarcinoma"},"content":{"rendered":"

El Colangiocarcinoma \u00e9s un tipus de c\u00e0ncer que s’origina en les c\u00e8l\u00b7lules que revesteixen les vies biliars.<\/p>\n

Es pot localitzar a les vies biliars de l’interior del fetge (intrahep\u00e0tic, en un 20-25% dels casos) o de l’exterior del fetge (extrahep\u00e0tic).<\/p>\n

El c\u00e0ncer extrahep\u00e0tic pot dividir-se en dos tipus: el situat m\u00e9s pr\u00f2xim al fetge i que es forma on es troben els conductes dret i esquerre (anomenat tumor perihiliar o tumor de Klatskin), que \u00e9s el m\u00e9s freq\u00fcent (50-60%), i el situat m\u00e9s proper al duod\u00e8 (tumor extrahep\u00e0tic distal, amb una freq\u00fc\u00e8ncia del 20-25%). En un 5% dels casos tenen una localitzaci\u00f3 multifocal.<\/p>\n

S\u00f3n factors de risc establerts d’aquest tumor algunes malalties que predisposen a la inflamaci\u00f3 cr\u00f2nica de la via biliar: la colangitis esclerosant prim\u00e0ria, la litiasi biliar intrahep\u00e0tica, els quists del col\u00e8doc i certes infeccions. Tamb\u00e9 es creu que s\u00f3n factors de risc la malaltia inflamat\u00f2ria cr\u00f2nica intestinal, la malaltia hep\u00e0tica cr\u00f2nica pel virus de l’hepatitis B o C, la cirrosi hep\u00e0tica, la diabetis, l’obesitat, l’alcohol i el tabac.<\/p>\n

Els s\u00edmptomes que ens poden fer sospitar un c\u00e0ncer de vies biliars s\u00f3n la coloraci\u00f3 groga de la pell (icter\u00edcia), la picor de pell (pru\u00efja) i l’orina de color fosc (col\u00faria), tot aix\u00f2 a causa de la interrupci\u00f3 de la sortida de la bilis del fetge. Tamb\u00e9 pot existir febre a causa de la infecci\u00f3 de la bilis estancada, i dolor abdominal. La falta de gana i p\u00e8rdua de pes sense causa aparent amb freq\u00fc\u00e8ncia ocorren quan la malaltia es diagnostica de manera avan\u00e7ada.<\/p>\n

L’anal\u00edtica de sang permet detectar la pres\u00e8ncia d’una alteraci\u00f3 de l’expulsi\u00f3 de la bilirubina en cas que hi hagi (bilirubina elevada), aix\u00ed com altres alteracions del funcionament hep\u00e0tic (transaminases, fosfatasa alcalina, … elevades).<\/p>\n

El marcador tumoral que pot estar elevat en aquest tumor \u00e9s el CA 19.9 per\u00f2 tamb\u00e9 pot estar elevat en moltes altres situacions pel que no serveix per fer el diagn\u00f2stic de la malaltia, sent m\u00e9s \u00fatil en el seu seguiment.<\/p>\n

La TC toracoabdominal permet confirmar l’exist\u00e8ncia del tumor, la seva localitzaci\u00f3, i valoraci\u00f3 d’extensi\u00f3 a \u00f2rgans ve\u00efns i allunyats del tumor, a vasos abdominals i a ganglis.<\/p>\n

De vegades una Colangiografia per resson\u00e0ncia (valora amb m\u00e9s deteniment la via biliar) pot definir millor l’extensi\u00f3 local del tumor i ajudar en la decisi\u00f3 de si un tumor \u00e9s operable o no.<\/p>\n

Es pot obtenir una bi\u00f2psia del tumor mitjan\u00e7ant una CPRE, una punci\u00f3 externa guiada amb ecografia abdominal o TC, o mitjan\u00e7ant una Ecoendosc\u00f2pia<\/a>. Per\u00f2 no sempre \u00e9s possible l’obtenci\u00f3 d’una bi\u00f2psia d’aquesta lesi\u00f3 a causa de la dif\u00edcil i profunda localitzaci\u00f3 del tumor. D’altra banda, en cas que el pacient sigui operable, tampoc la bi\u00f2psia pot ser necess\u00e0ria abans de la cirurgia.<\/p>\n

Previ a la cirurgia amb opci\u00f3 curativa de vegades es realitza una laparosc\u00f2pia exploradora per descartar amb m\u00e9s seguretat un tumor irresecable.<\/p>\n

L’opci\u00f3 de tractament curatiu \u00e9s la cirurgia. Hi ha diverses opcions segons el tram afecte de la via biliar: la duodenopancreatectomia cef\u00e0lica (extirpaci\u00f3 del cap del p\u00e0ncrees, part de l’est\u00f3mac, el duod\u00e8, el conducte biliar i la ves\u00edcula biliar) per tumors del conducte biliar distal, la resecci\u00f3 d’una porci\u00f3 del fetge en tumors hiliares i en alguns casos resecci\u00f3 exclusiva d’una porci\u00f3 de conducte biliar quan es localitza en una zona del conducte interm\u00e8dia (i per tant allunyada del fetge, del duodeno i p\u00e0ncrees).<\/p>\n

En alguns casos de tumor hiliar localment extens per\u00f2 sense malaltia en \u00f2rgans a dist\u00e0ncia ha l’opci\u00f3 de realitzar trasplantament hep\u00e0tic.<\/p>\n

La reconstrucci\u00f3 biliar sol realitzar-se mitjan\u00e7ant una hepaticoyeyunostom\u00eda en Y de Roux (entroncament de la via biliar pr\u00f2xima al fetge a un tram de l’intest\u00ed prim anomenat jej\u00fa).<\/p>\n

Entre les complicacions del tractament quir\u00fargic s’inclouen: la infecci\u00f3 intraabdominal (absc\u00e9s), la f\u00edstula biliar, o la decisi\u00f3 de la funci\u00f3 hep\u00e0tica de forma lleu, moderada o greu (en alguns casos que fa falta extirpar part del fetge per treure tot el tumor).<\/p>\n

Tot i que la cirurgia elimini tot el tumor, hi ha risc que torni a apar\u00e8ixer i per aix\u00f2 en alguns casos s’administra posteriorment quimioter\u00e0pia-radioter\u00e0pia (adjuvant). D’altra banda, tamb\u00e9 s’administra aquest tractament quan no ha estat possible realitzar l’extirpaci\u00f3 completa del tumor durant la cirurgia.<\/p>\n

Per\u00f2 \u00e9s m\u00e9s freq\u00fcent que el tumor es diagnostiqui massa tard i no sigui resecable, b\u00e9 per l’extensi\u00f3 local que envaeix estructures ve\u00efnes, o b\u00e9 per la pres\u00e8ncia de malaltia en \u00f2rgans allunyats del tumor (met\u00e0stasi).<\/p>\n

Moltes vegades es realitza un procediment de desviament de la via biliar perqu\u00e8 la bilis no quedi estancada i sorgeixin complicacions degudes a aix\u00f2. Es pot realitzar col\u2022locant un petit tub de pl\u00e0stic o de metall (pr\u00f2tesis) mitjan\u00e7ant CPRE, o des de fora de l’abdomen guiat per ecografia o TC, o b\u00e9 mitjan\u00e7ant Cirurgia. Ocasionalment tamb\u00e9 es realitza el drenatge de la via biliar abans de la cirurgia amb intenci\u00f3 curativa. A aquests pacients se’ls sol administrar tamb\u00e9 quimioter\u00e0pia amb o sense radioter\u00e0pia.<\/p>\n

\u00c9s important la valoraci\u00f3 multidisciplinari del pacient per especialistes experts en aquest tipus de tumors: digestiu, cirurgi\u00e0, radi\u00f2leg, onc\u00f2leg, radioterapeuta, … per realitzar un maneig adequat segons la situaci\u00f3 de cada pacient.<\/p>\n","protected":false},"excerpt":{"rendered":"

El Colangiocarcinoma \u00e9s un tipus de c\u00e0ncer que s’origina en les c\u00e8l\u00b7lules que revesteixen les vies biliars. Es pot localitzar a les vies biliars de l’interior del fetge (intrahep\u00e0tic, en un 20-25% dels casos) o […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":0,"parent":8679,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-8683","page","type-page","status-publish"],"yoast_head":"\nColangiocarcinoma - Servidigest<\/title>\n<meta name=\"description\" content=\"El Colangiocarcinoma \u00e9s un tipus de c\u00e0ncer que s'origina en les c\u00e8l\u2022lules que revesteixen les vies biliars.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/dev.93-93-113-41.plesk.page\/ca\/serveis\/aparell-digestiu\/pancrees-i-vies-biliars\/cancer-de-via-biliar\/colangiocarcinoma\/\" \/>\n<meta property=\"og:locale\" content=\"ca_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Colangiocarcinoma - 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