BILIARY MALIGNANCIES

Biliary malignancies, including cancers of the intrahepatic and extrah epatic bile ducts, gallbladder and ampulla, should be considered in th e differential diagnosis of patients with obstructive jaundice. Cancer s of the intrahepatic bile ducts and ampulla are managed as liver and peri-ampullary tumours respectively. Extrahepatic bile duct cancers ar e diagnosed by cholangiography and evaluated for resectability by imag ing and angiography. Vascular infiltration is the main contra-indicati on for resection, which may also involve the liver. Every attempt must be made to achieve curative resection, but local resection may be jus tified even if non-curative. Gallbladder cancers are usually advanced at the time of diagnosis and are unresectable-surgical palliation impr oves the quality of life by relieving biliary and gastric outlet obstr uction. Long-term survival is possible after curative resection in ear ly lesions that are usually diagnosed as an incidental finding after c holecystectomy for presumed gallstone disease. The role of adjuvant th erapy in biliary malignancies needs further evaluation.