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Diagnostic and Staging Workup

Patients usually present with jaundice, abnormal liver enzymes, pain, or dilated bile ducts on imaging
Patients with suspected cholangiocarcinomas should be referred to a hepatobiliary surgeon with expertise in this area
Initial investigations should include:

Liver imaging: Triphasic CT scan or contrast-enhanced MRI
Cholangiography either by MRCP or ERCP. (ERCP and stenting may be preferable for symptomatic patients)
Metastatic work-up to include CT chest
CEA and CA 19-9

Extent of the disease should be assessed by cross-sectional imaging and cholangiography to determine proximal and distal extent of the disease.
A tissue diagnosis may be attempted by:

ERCP + brushings
EUS + FNA bx
Percutaneous biopsy of suspected mass

Obtaining a definitive tissue diagnosis is frequently not possible. If a lesion is potentially resectable, surgery should be considered even in the absence of a tissue diagnosis
If a patient has a potentially resectable lesion, preoperative drainage of the biliary tract should be considered either by ERCP or PTC. The biliary system to be drained should be determined by the type of operation being planned
Laparoscopy may be considered for staging

SOURCE: Diagnostic and Staging Workup ( )
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