Biliary tract cancer

Investigation into the molecular and cellular biology of carcinogenesis con tinues to elucidate potential mechanisms for the initiation and progression of biliary tract cancer. The potential role of cell cycle regulators, such as Fas ligand, has been examined in the etiology of bile duct carcinoma. I n addition, there is evidence for a possible link between chronic inflammat ion and malignant transformation through the relation between nitric oxide and DNA repair enzymes. Noninvasive imaging modalities, including helical c omputed tomography scanning, magnetic resonance cholangiopancreatography (M RCP) and positron emission tomography (PET) scanning, are gaining acceptanc e and may eventually supplant standard methods of evaluation. In addition, innovative tissue-sampling modalities including choledochoscopy are being d eveloped. Several large series, Japanese and Western, continue to report im proved 5-year survival rates after aggressive surgical resections of hilar cholangiocarcinoma. Although chemotherapeutic options remain limited in bil iary tract carcinoma, radiation therapy may provide a benefit in local cont rol in patients with microscopically positive margins. Photodynamic and mul timodality therapy also may become important components of improving pallia tion for patients with advanced disease. Curr Opin Gastroenterol 2000, 16:4 37-443 (C) 2000 Lippincott Williams & Wilkins, Inc.