概述

胆管癌是一种在输送消化液胆汁的细长管道(胆管)中形成的癌症。胆管连接着肝脏、胆囊和小肠。

胆管癌也称为胆道癌,虽然可能发生在任何年龄段,但主要发生在 50 岁以上的人群中。

医生根据胆管癌在胆管中的发生部位,将其分为不同的类型:

  • 肝内胆管癌发生在肝内胆管各部分,有时也归类为一种肝癌。
  • 肝门部胆管癌只发生在肝外胆管内。这种也叫做肝门周围胆管癌。
  • 远端胆管癌发生在最接近小肠的胆管内部。这种类型的胆管癌也叫做肝外胆管癌。

胆管癌通常在晚期才诊断出,因此治疗难以成功。

Types

症状

胆管癌的体征和症状包括:

  • 皮肤和眼白发黄(黄疸)
  • 皮肤剧烈瘙痒
  • 白色大便
  • 疲劳
  • 右侧肋骨下方腹痛
  • 体重意外下降
  • 发热
  • 盗汗
  • 尿色深

何时就诊

如果您出现持续的疲劳、腹痛、黄疸或其他困扰您的体征和症状,请就医。医生可能会将您转诊给消化系统疾病专科医生(肠胃科医生)。

病因

当胆管细胞的 DNA 发生变化时,就有可能发展成胆管癌。细胞的 DNA 包含指示细胞该如何做的指令。DNA 变化会让细胞失控增殖,形成细胞团块(肿瘤),侵入并破坏正常身体组织。导致胆管癌的 DNA 变化的诱因尚不清楚。

风险因素

增加患胆管癌风险的因素包括:

  • 原发性硬化性胆管炎。这种疾病会引起胆管硬化和瘢痕形成。
  • 慢性肝病。由慢性肝病引起的肝脏瘢痕形成会增加患胆管癌的风险。
  • 出生即存在的胆管问题。出生时就有胆总管囊肿(该疾病会导致胆管扩张和不规则)的人患胆管癌的风险会更高。
  • 肝脏寄生虫。在东南亚地区,胆管癌通常和肝吸虫感染有关。吃生鱼或未煮熟的鱼都可能发生这种感染。
  • 年龄较大。胆管癌常见于 50 岁以上的人群。
  • 抽烟。抽烟与患胆管癌的风险增加相关。
  • 糖尿病。1 型或 2 型糖尿病患者患胆管癌的风险增加。
  • 某些遗传病。一些由父母遗传给孩子的 DNA 变化会导致医疗状况,增加胆管癌风险。这些病症包括囊性纤维化和林奇综合征。

预防

为降低患胆管癌的风险,可采取的措施有:

  • 戒烟。抽烟与患胆管癌的风险增加有关。如果您抽烟,请戒烟。如果您过去曾尝试戒烟但没有成功,请向医生咨询有助于您戒烟的策略。
  • 降低患肝病的风险。慢性肝病与患胆管癌的风险增加有关。有些肝病的病因无法预防,但另一些则可以预防。尽您所能做好肝脏护理。

    例如,为了降低出现肝脏发炎(肝硬化)的风险,如要饮酒,请适度。对于健康成人,女性每天最多喝一杯,男性每天最多喝两杯。保持健康的体重。使用化学品时,要遵守安全说明。

在 Mayo Clinic 治疗

June 06, 2023

Living with 胆管癌(胆道癌)?

Connect with others like you for support and answers to your questions in the Transplants support group on Mayo Clinic Connect, a patient community.

Transplants Discussions

lmctif
Liver transplant - Let's support each other

1565 Replies Wed, May 01, 2024

nikkispk
SPK (simultaneous pancreas and kidney) transplants

73 Replies Wed, May 01, 2024

Lori, Volunteer Mentor
My Bone Marrow Transplant (BMT/SCT) story: Will you share yours?

362 Replies Tue, Apr 30, 2024

See more discussions
  1. AskMayoExpert. Cholangiocarcinoma (adult). Mayo Clinic; 2020.
  2. Feldman M, et al., eds. Tumors of the bile ducts, gallbladder and ampulla. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed Jan. 14, 2021.
  3. Bile duct cancer (cholangiocarcinoma). Cancer.Net. https://www.cancer.net/cancer-types/bile-duct-cancer/view-all. Accessed April 6, 2021.
  4. Hepatobiliary cancers. National Comprehensive Cancer Network. https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1438. Accessed Jan. 14, 2021.
  5. Choi J, et al. Aspirin use and the risk of cholangiocarcinoma. Hepatology. 2016; doi:10.1002/hep.28529.
  6. Banales JM, et al. Cholangiocarcinoma 2020: The next horizon in mechanisms and management. Nature Reviews Gastroenterology & Hepatology. 2020; doi:10.1038/s41575-020-0310-z.
  7. Bile duct cancer (cholangiocarcinoma) treatment — Health professional version (PDQ). National Cancer Institute. https://www.cancer.gov/types/liver/hp/bile-duct-treatment-pdq. Accessed April 6, 2021.
  8. Lowe RC, et al. Clinical manifestations and diagnosis of cholangiocarcinoma. https://www.uptodate.com/contents/search. Accessed April 6, 2021.
  9. Anderson CD. Surgical resection of localized cholangiocarcinoma. https://www.uptodate.com/contents/search. Accessed April 6, 2021.
  10. Bergquist JR, et al. Implications of CA-19 elevation for survival, staging, and treatment sequencing in intrahepatic cholangiocarcinoma: A national cohort analysis. Journal of Surgical Oncology. 2016; doi:10.1002/jso.24381.
  11. Lavu S, et al. Effect of statins on the risk of extrahepatic cholangiocarcinoma. 2020; doi:10.1002/hep.31146.
  12. Rea DJ, et al. Liver transplantation with neoadjuvant chemoradiation is more effective than resection for Hilar cholangiocarcinoma. 2005; doi:10.1097/01.sla.0000179678.13285.fa.
  13. Giridhar KV (expert opinion). Mayo Clinic. May 4, 2021.
  14. Petrick JL, et al. Risk factors for intrahepatic and extrahepatic cholangiocarcinoma in the United State: A population-based study in SEER-Medicare. PLoS ONE. 2017; doi:10.1371/journal.pone.0186643.
  15. Yamada A, et al. Risk of gastrointestinal cancers in patients with cystic fibrosis: A systematic review and meta-analysis. Lancet Oncology. 2018; doi:10.1016/S1470-2045(18)30188-8.
  16. Genetic/familial high-risk assessment: Colorectal. National Comprehensive Cancer Network. https://www.nccn.org/guidelines/guidelines-detail?category=2&id=1436. Accessed May 28, 2021.