Cholangiocarcinoma--controversies and challenges.
Cholangiocarcinoma--controversies and challenges.
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DOI：
10.1038/nrgastro.2011.20
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发表时间：
2011-04
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影响因子：
--
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中科院分区：
文献类型：
--
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胆管癌是一组不同的肿瘤，据推测起源于肝脏或胆道内的胆道上皮。这些癌症往往难以诊断，其发病机制知之甚少，其惨淡的预后导致其管理的虚无主义方法。两种主要的临床表型是肝内肿块形成肿瘤和大导管肿瘤。在导管癌中，肝门处的病变最常见。这两种类型的胆管癌的危险因素，临床表现，自然史和管理是不同的。改善这些疾病患者预后的努力受到有效管理的几个挑战的影响。例如，根据解剖特征的命名方法不一致，混淆了流行病学趋势分析和风险因素评估。由于缺乏对不同表型的认识，对治疗选择，特别是全身治疗的评价受到限制。关于适当的检查和管理方法的选择存在争议。然而，新的和新兴的工具，以改善诊断，扩大适应症的手术方法，一个新兴的作用，局部和胆道内治疗和改善全身治疗提供了乐观和希望，改善的结果在未来。
Cholangiocarcinomas are a diverse group of tumors that are presumed to originate from the biliary tract epithelium either within the liver or the biliary tract. These cancers are often difficult to diagnose, their pathogenesis is poorly understood, and their dismal prognosis has resulted in a nihilistic approach to their management. The two major clinical phenotypes are intrahepatic, mass-forming tumors and large ductal tumors. Among the ductal cancers, lesions at the liver hilum are most prevalent. The risk factors, clinical presentation, natural history and management of these two types of cholangiocarcinoma are distinct. Efforts to improve outcomes for patients with these diseases are affected by several challenges to effective management. For example, designations based on anatomical characteristics have been inconsistently applied, which has confounded analysis of epidemiological trends and assessment of risk factors. The evaluation of therapeutic options, particularly systemic therapies, has been limited by a lack of appreciation of the different phenotypes. Controversies exist regarding the appropriate workup and choice of management approach. However, new and emerging tools for improved diagnosis, expanded indications for surgical approaches, an emerging role for locoregional and intrabiliary therapies and improved systemic therapies provide optimism and hope for improved outcomes in the future.
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