Bile duct cancer ICD 10. Malignant liver tumors. Hepatocellular and cholangiocellular cancer. Tumor diagnostic methods
Resection of a single metastasis up to 5 cm in size allows increasing the average five-year survival rate of patients with rectal cancer to 30-40%. With multiple lesions, the prognosis after surgical treatment of metastatic liver cancer is less favorable, however, with the removal of all foci, an average three-year survival rate of 30% can be achieved. Mortality in the postoperative period is 3-6%. For primary malignant tumors of other locations, with the exception of rectal cancer (lung cancer, breast cancer), the prognosis after resection of hepatic metastases is less optimistic.
IN last years the list of indications for surgery for metastatic liver cancer has expanded. Sometimes oncologists recommend resection if there are metastases not only in the liver, but also in the lungs. The operation is performed in two stages: first, the lesion is removed in the liver, then in the lung. There are no statistical data on changes in life expectancy with such interventions yet. For inoperable metastatic liver cancer, chemotherapy is indicated. Patients are prescribed 5-fluorouracil (sometimes in combination with calcium folinate), oxaliplatin. Average duration life after drug treatment ranges from 15 to 22 months.
In some cases, chemotherapy can reduce tumor growth and allow surgery for metastatic liver cancer that was considered inoperable before treatment. Resection becomes possible in approximately 15% of patients. The average life expectancy is the same as for initially operable tumors. In all cases, after removal of metastatic liver cancer in the long term, new secondary lesions may appear in various organs. For resectable liver metastases, repeat resection is performed. For metastatic damage to other organs, chemotherapy is prescribed.
Along with classical surgical interventions and chemotherapy, for metastatic liver cancer, embolization of the hepatic artery and portal vein, radioablation, cryodestruction and the introduction of ethyl alcohol into the area of the tumor are used. As a result of embolization, the nutrition of the tumor is disrupted, and necrotic changes occur in the tissues. The simultaneous administration of chemotherapy drugs through a catheter makes it possible to create a very high concentration of drugs in the tumor tissue, which further increases the effectiveness of the technique. Chemoembolization can be used as a independent method treatment of metastatic liver cancer or used at the stage of preparing the patient for organ resection.
The purpose of radiofrequency ablation, cryodestruction and the introduction of ethyl alcohol is also to destroy tumor tissue. Experts note the promise of these techniques, but do not report statistical data on changes in survival after their use, so it is still difficult to assess long-term results. The mortality rate of patients with metastatic liver cancer using these methods is about 0.8%. In advanced cases, when surgical treatment, chemotherapy, embolization, radioablation or cryodestruction is impossible due to the serious condition of the patient, symptomatic medications are prescribed to mitigate the manifestations of the disease. Life expectancy for metastatic liver cancer in such cases usually does not exceed several weeks or months.
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Short description
Benign tumors gallbladder rare (papillomas, adenomyomas, fibromas, lipomas, fibroids, myxomas and carcinoids).
Code by international classification diseases ICD-10:
Gallbladder cancer is 4% of total number malignant epithelial neoplasms of the gastrointestinal tract. This tumor is detected in 1% of patients undergoing operations on the gallbladder and biliary tract. In women, gallbladder cancer is diagnosed 3 times more often
Etiology unknown. 90% of cancer patients suffer from gallstones. About 80% of all gallbladder carcinomas are adenocarcinomas. Characterized by local invasive growth into liver tissue. Tumors metastasize to the pancreas, duodenal and hepatic lymph nodes
Clinical picture Gallbladder cancer is very aggressive, often metastasizing to distant organs even before the clinical manifestation of the disease. Pain in the right upper quadrant of the abdomen, often nausea and vomiting. Organ carcinomatosis often develops. abdominal cavity, ascites The diagnosis is rarely made before surgery, which is usually performed for cholelithiasis.
TNM classification(see also Tumor, stages) Tis - carcinoma in situ T1 - the tumor invades the mucous membrane or muscular layer of the bladder wall T2 - the tumor spreads to the perimuscular connective tissue, but does not invade the visceral peritoneum or the liver T3 - the tumor invades the visceral peritoneum or directly invades into one adjacent organ (grows into the liver no more than 2 cm) T4 - the presence of one of the following signs: the tumor grows into the liver more than 2 cm; the tumor grows into more than two neighboring organs (stomach, duodenum, colon, pancreas, omentum, extrahepatic bile ducts) N1 - metastases in the lymph nodes near the cystic and common bile ducts and/or hilum of the liver N2 - metastases in the lymph nodes located near head of the pancreas, duodenum, portal vein, celiac and superior mesenteric arteries.
Grouping by stages Stage 0: TisN0M0 Stage I: T1N0M0 Stage II: T2N0M0 Stage III T3N0M0 T1–3N1M0 Stage IV T4N0–1M0 T1–4N2M0 T1–4N0–2M1.
Treatment. There is a chance of cure in cases where a gallbladder tumor is discovered by chance, for example, during a cholecystectomy undertaken for other reasons. If the tumor extends beyond the gallbladder, it is necessary to perform cholecystectomy with marginal liver resection and regional lymphadenectomy.
Forecast in case of gallbladder cancer, it is poor due to the advanced stage of the tumor. The most common occurrence is liver invasion, which occurs in approximately 70% of patients undergoing surgery. Overall 5-year survival rate is less than 10%. If there is obstruction of the common bile duct (by a tumor or lymph nodes), it is possible to perform symptomatic intervention: stenting with an endoprosthesis, hepaticojejunostomy, transhepatic cholangiostomy.
Pathological anatomy. Cholangiocarcinoma (most tumors are scirrhous or papillary type) - severe fibrosis often makes diagnosis difficult. On macroscopic examination, cholangiocarcinoma is a tumor-like formation involving part of the bile ducts. It is often difficult to distinguish cholangiocarcinoma from sclerosing cholangitis. Tumor localization is the distal parts of the common bile duct (1/3 of cases), the common hepatic or cystic duct (1/3 of cases), the right or left hepatic duct.
Damage to the confluence of the right and left bile ducts is defined as Klatskin tumor. This type of cancer metastasizes to regional lymph nodes (16% of cases) and liver (10%). Direct tumor growth into the liver is possible (14%).
Clinical picture Due to the small diameter of the ducts, signs of duct obstruction appear already at small sizes primary tumor. Severe jaundice, itchy skin, lack of appetite, weight loss and constant aching pain in the right upper quadrant of the abdomen develop.
Laboratory data. The content of serum alkaline phosphatase, direct and total bilirubin was significantly increased. The content of serum transaminases was less significantly changed.
Diagnosis can be established using percutaneous transhepatic cholangiography or endoscopic retrograde cholangiopancreatography. Both tests allow biopsy of suspicious areas of tissue for histological examination.
TNM classification(see also Tumor, stages) Tis - carcinoma in situ T1 - the tumor grows into the subepithelial connective tissue or muscle-connective tissue layer T2 - the tumor spreads to the perimuscular connective tissue T3 - the tumor spreads to adjacent structures: liver, pancreas, duodenum, bile bladder, colon, stomach N1 - metastases in the lymph nodes near the cystic and common bile ducts and/or the gates of the liver (i.e. in the hepatoduodenal ligament) N2 - metastases in the lymph nodes located near the head of the pancreas, duodenum, celiac and superior mesenteric arteries, posterior peripancreatoduodenal lymph nodes.
Grouping by stages Stage 0: TisN0M0 Stage I: T1N0M0 Stage II: T2N0M0 Stage III: T1–2N1–2M0 Stage IV T3N0–2M0 T1–3N0–2M1.
Treatment- surgical, but the tumor resectability does not exceed 10% For tumors of the distal parts of the common bile duct, pancreaticoduodenectomy (Whipple procedure) is performed with further restoration of the patency of the biliary tract and gastrointestinal tract. If the tumor is localized in more proximal parts, the tumor is excised followed by reconstruction of the common bile duct. The average life expectancy of patients after surgery is 23 months. Radiation therapy in the postoperative period can increase life expectancy. If the tumor cannot be removed, it is tunneled. Through the resulting channel, a permanent drainage is carried out, opening on one side into the intrahepatic ducts proximal to the tumor, and on the other hand into the common bile duct distal to the tumor. It is possible to introduce external drainage during percutaneous transhepatic cholangiography. For palliative purposes, drainage with a U-shaped tube according to Praderi is indicated. Both ends of the drainage are brought to the skin: one is similar to the drainage of the common bile duct, the other - through the tumor tissue, liver parenchyma and abdominal wall. The advantage of U-shaped drainages is that they can be replaced in case of obstruction with tissue detritus. A new drainage tube is sutured to the end of the previously installed one and replacement is carried out by tightening the drainage. Installing a drainage increases life expectancy by 6–19 months.
Forecast Distant metastasis of common bile duct cancer usually occurs late and, as a rule, is not the direct cause of death. Causes of death Biliary cirrhosis due to inadequate outflow of bile Intrahepatic infection with the formation of abscesses General exhaustion, decreased reactivity of the body Sepsis.
ICD-10 C23 Malignant neoplasm of the gallbladder C24 Malignant neoplasm of other and unspecified parts of the biliary tract D13.4 Benign neoplasm of the liver
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Malignant liver tumors include primary cancer, diffuse types of sarcomas, as well as metastatic liver damage from tumors of other locations.
Secondary liver tumors arise as a result of hematogenous or lymphogenous metastasis of tumors in other locations. The frequency of metastatic liver disease significantly exceeds the frequency of primary liver tumors, accounting for approximately 95% of all malignant neoplasms of this organ.
In Russia, primary liver cancer currently accounts for 1.8% of all malignant tumors. Liver metastases are found in 20-70% of cancer patients, including 50% of patients who have undergone colon resection for cancer.
The highest incidence of primary liver cancer is observed in countries South Africa And South-East Asia, where the incidence reaches 30 per 100,000 population. Relatively prosperous regions are Northwestern Europe and North America, where the incidence is 2 per 100,000 population.
Primary malignant liver tumors
Types of tumors
In accordance with the international histogenetic classification of liver tumors (Hamilton, 2000), the following types of primary malignant tumors are distinguished.Epithelial tumors:
- hepatocellular carcinoma (hepatocellular carcinoma);
- intrahepatic cholangiocarcinoma (cancer of the intrahepatic bile ducts);
- bile duct cystadenocarcinoma;
- combined hepatocellular and cholangiocellular carcinoma (mixed hepatocholangiocellular carcinoma);
- hepatoblastoma;
- undifferentiated carcinoma (cancer).
- epithelioid hemangioendothelioma;
- angiosarcoma;
- embryonal sarcoma (undifferentiated sarcoma);
- rhabdomyosarcoma (occurs mainly in children in the first 5 years of life).
- carcinosarcoma;
- Kaposi's sarcoma;
- rhabdoid tumor.
Hepatocellular cancer
Hepatocellular cancer (ICD-10 code - C22.0) is the most common epithelial malignant tumor of the liver. Accounts for 85% of all primary malignant neoplasms of this organ. Every year, 1.2 million people worldwide die from hepatocellular cancer (2 per 100,000 in North America and 30 in Southeast Asia). Most affected age group- 40-50 years.Etiology
Hepatocellular cancer most often develops against the background of liver cirrhosis, caused by hepatitis B and C (more than 80% of patients with hepatocellular cancer have concomitant cirrhosis). Alcoholic cirrhosis also predisposes to the development of this neoplasm, but to a much lesser extent than cirrhosis of viral etiology. Aflatoxin poisoning, hereditary hemochromatosis, tyrosinemia, primary biliary cirrhosis also contribute to the development of hepatocellular carcinoma, but the significance of these causes in its development is small.Tumor forms
There are 3 main macroscopic forms of hepatocellular cancer: nodular, massive and diffuse. The massive form of cancer has 2 variants: in the first it is represented by a single large node (massive simple form), in the second - one large node with metastases along the periphery (massive form with satellites).By histological structure There are 4 types of hepatocellular carcinoma. Most common trabecular type, in which tumor cells form trabeculae separated by sinusoidal vessels. Other histological variants are less common: pseudoglandular(acinar), compact And scirrhosous.
A special variant of hepatocellular cancer - fibrolamellar carcinoma. This form has a more favorable course and occurs against the background of unchanged liver parenchyma in patients young. Macroscopically, the tumor has a whitish, gray or greenish color, is clearly demarcated from the healthy liver, and has a stellate scar in the center.
Depending on the level of differentiation of the tumor, there are well-differentiated, moderately differentiated, poorly differentiated and undifferentiated hepatocellular cancer.
Cholangiocellular carcinoma
Cholangiocellular cancer (ICD-10 code - C22.1)- the second most common primary malignant tumor of the liver. Cholangiocarcinoma accounts for 10% of all primary liver tumors. Most common in Southeast Asian countries and Far East, where its frequency reaches 20%.Etiology
Cholangiocellular cancer is rarely combined with liver cirrhosis - in 4-7% of cases. Risk factors, contributing to the occurrence of cholangiocellular cancer:- primary sclerosing cholangitis;
- nonspecific ulcerative colitis;
- Caroli syndrome;
- polycystic liver disease.
Tumor forms
Depending on the location, there are 3 main types of cholangiocarcinoma: intrahepatic, hilus and distal.Intrahepatic cholangiocarcinomas According to macroscopic characteristics, they are divided into 3 types: massive, intraductal infiltrating and intraductal(with papillary growth or formation of a tumor thrombus).
At histological examination cholangiocellular carcinoma usually looks like a typical well-differentiated adenocarcinoma, which significantly complicates its differential diagnosis with hepatocellular cancer and metastases of adenocarcinoma.
V.D. Fedorov, V.A. Vishnevsky, N.A. Nazarenko
