Cholangiocarcinoma is an uncommon tumor that may occur anywhere along the intrahepatic or extrahepatic biliary tree. In the United States approximately 5,000 cholangiocarcinomas are diagnosed per year while many more biliary malignancies occur in Asia. The hepatic duct bifurcation is the most frequently involved site, and approximately 50-70 % of cholangiocarcinomas are found in this perihilar region . The role of radiation therapy, chemoradiation and chemotherapy as adjuvants to surgical resection in patients with perihilar cholangiocarcinoma remains controversial. Aggressive surgical resection obtaining a negative microscopic margin offers the only chance for long-term survival. However, many patients will only be candidates for nonoperative stenting or palliative surgery aimed to provide biliary drainage and prevent cholangitis and hepatic failure. Radiation therapy, chemoradiation and/or chemotherapy also can be used in these patients with nonresectable disease in an attempt to palliate symptoms and extend survival.
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