Liver Fluke, Opisthorchis viverrini Related Cholangiocarcinoma: Liver Fluke Related Cholangiocarcinoma (Recent Results in Cancer Research, 219)

This volume discusses new developments in the etiology, diagnosis, and treatment of cholangiocarcinoma induced by the liver fluke Opisthorchis viverrini. Although cholangiocarcinoma is rare in the Western world, it has a very high incidence in continental Southeast Asian countries, where it is linked to infection with O. viverrini. In Southeast Asia this cancer causes thousands of deaths every year and places a severe socioeconomic burden on the affected families. Diagnosis is usually at a late disease stage, and in the past palliative surgery and care have been the major therapeutic options. Recently, however, techniques have become available for early-stage diagnosis that offer the possibility of curative surgery, and novel chemotherapeutic options are also under development. In Thailand alone, more than 2 million individuals have now been registered for screening for this cancer. The aim of this book is to highlight the latest research in the field and to explain how the newly available techniques can be applied to reduce the risk of developing cholangiocarcinoma and increase the likelihood of survival. Contents 1 Introduction References 2 Opisthorchis viverrini Life Cycle, Distribution, Systematics, and Population Genetics 2.1 Introduction 2.2 Biology 2.2.1 Morphology 2.2.2 Life Cycle 2.2.3 Source of Infections 2.3 Distribution 2.4 Systematics and Population Genetics 2.4.1 The Liver Fluke O. viverrini 2.4.2 The Bithynia Snail Host 2.5 Biological and Morphological Variations References 3 Epidemiology and Control of Opisthorchis viverrini Infection: Implications for Cholangiocarcinoma Prevention 3.1 Preface 3.2 Background 3.3 Tools for Screening, Surveillance, and Control Program 3.3.1 Isan Cohort 3.3.2 New Urine Assay for OV Screening 3.3.3 Teleconsultation Ultrasonography 3.4 Intervention and Solution 3.4.1 The Primary Prevention Program: Food Safety, School-Based Health Education, and Screening of O. viverrini 3.4.2 Secondary Prevention Program 3.4.3 Tertiary Patient Care Program: Confirmation and Management of Suspected CCA 3.5 Past and Current Control Programs 3.5.1 Education 3.5.2 Medication 3.5.3 Sanitation 3.5.4 Comprehensive Control Program 3.6 Modeling for Control of O. viverrini Related Pathology and Carcinogenesis 3.7 Progress Toward Control of OV and CCA 3.8 Summary References 4 The Hallmarks of Liver Fluke Related Cholangiocarcinoma: Insight into Drug Target Possibility 4.1 Host–Parasite Interactions: Chronic Infection-Induced Inflammation-Related CCA Development 4.2 Hallmarks of Ov-Related CCA 4.3 Sustaining Proliferative Signaling 4.4 Evading Growth Suppressors 4.5 Resisting Cell Death 4.6 Enabling Replicative Immortality 4.7 Inducing Angiogenesis 4.8 Activation of Invasion and Metastasis 4.9 Enabling Characteristics and Emerging Hallmarks 4.9.1 Genome Instability and Mutation 4.9.2 Tumor-Promoting Inflammation 4.9.3 Reprogramming Energy Metabolism 4.9.4 Evading Immune Destruction 4.9.5 The Tumor Microenvironment 4.10 Molecular Heterogeneity and Therapeutic Opportunities 4.10.1 Genetic Profiling of iCCA and Its Clinical Implication in Targeted Therapy 4.10.2 Genetic Profiling of eCCA and Its Clinical Implication in Targeted Therapy 4.11 Conclusion References 5 Pathology of Cholangiocarcinoma 5.1 Pathology 5.2 Spreading Pattern of Cholangiocarcinoma 5.3 Surgery and Residual Tumor 5.4 Prognosis 5.5 Biomarkers 5.6 Intrahepatic Cholangiocarcinoma; iCCA 5.7 Macroscopic Features 5.8 Histopathology 5.9 Cancer Staging 5.10 Extrahepatic Cholangiocarcinoma 5.11 Macroscopic Features 5.12 Histopathology 5.13 Cancer Staging 5.14 Molecular Pathology and Specimen Handling References 6 New Imaging Techniques 6.1 Imaging of Cholangiocarcinoma 6.1.1 The Role of Imaging in CCA Diagnosis 6.1.2 Anatomical and Morphological Classification 6.1.3 Ultrasound Screening of CCA 6.1.4 Ultrasound Findings of MF-CCA 6.1.5 Ultrasound Findings of PI-CCA 6.1.6 Ultrasound Findings of ID-CCA 6.1.7 Use of CT in CCA Diagnosis 6.1.8 Imaging Protocols 6.1.9 Diagnosis of Cholangiocarcinoma 6.1.10 Perihilar Cholangiocarcinoma 6.1.11 Intrahepatic Cholangiocarcinoma 6.1.12 Distal Cholangiocarcinoma 6.1.13 Staging and Treatment Planning 6.1.14 CT Volumetry and Estimation of Future Liver Remnant 6.1.15 Post-treatment Follow-Up and Surveillance 6.1.16 MRI Imaging of Cholangiocarcinoma 6.1.17 Positron Emission Tomography (PET)/CT of Cholangiocarcinoma 6.1.18 Magnetic Resonance Imaging and Relaxometry 6.1.19 Limitations to Contrast and Resolution 6.1.20 Internal Receivers for CCA Imaging 6.1.21 In Vitro Imaging of CCA References 7 Surgery 7.1 Part I: Surgical Anatomy of the Liver and Biliary Tract 7.1.1 Liver Anatomy 7.1.2 Pancreas Anatomy 7.2 Part II Pre-operative Treatment for CCA 7.2.1 Clinical Presentation for Each Type in Different Symptoms 7.2.2 Liver Function Assessment 7.2.3 Volume Assessment Method 7.2.4 Pre-operative Biliary Drainage 7.2.5 Portal Vein Embolization 7.3 Part III: Surgery for Intrahepatic Cholangiocarcinoma 7.3.1 General Consideration 7.3.2 Patient Selection 7.3.3 Margin of Resection 7.3.4 Role of Lymph Node Dissection 7.3.5 Vascular Resection for iCCA 7.3.6 Resection After Neoadjuvant Treatment 7.3.7 Resection of Tumor Recurrence 7.3.8 Special Consideration for Intraductal Growth Subtype 7.4 Part IV: Surgery for Perihilar Cholangiocarcinoma 7.4.1 Definition of Perihilar Cholangiocarcinoma 7.4.2 Assessment of Curative Resectability 7.4.3 Surgical Technique 7.4.4 Left and Right Trisectionectomy 7.4.5 Hepatopancreatoduodenectomy (HPD) 7.5 Part V: Surgical Treatment in Distal Cholangiocarcinoma 7.5.1 Assessment of Resectability 7.5.2 Arterial Approach Pancreaticoduodenectomy 7.5.3 Extended Lymphadenectomy 7.5.4 Resection Part 7.5.5 Reconstruction Part 7.6 Part VI: Minimally Invasive Surgery in Cholangiocarcinoma 7.6.1 Intrahepatic Cholangiocarcinoma 7.6.2 Distal Bile Duct Cholangiocarcinoma 7.7 Part VII: Role of Liver Transplantation in Cholangiocarcinoma 7.7.1 Background 7.7.2 Hilar Cholangiocarcinoma and Liver Transplantation 7.7.3 Liver Transplantation Versus Liver Resection 7.7.4 Intrahepatic Cholangiocarcinoma and Liver Transplantation References 8 Systemic Treatment for Cholangiocarcinoma 8.1 Introduction 8.2 Neoadjuvant Treatment in Cholangiocarcinoma 8.2.1 Resectability Criteria and Rationale of Neoadjuvant Therapy 8.2.2 Clinical Data and Ongoing Data 8.2.3 Ongoing Clinical Trials 8.2.4 Future Perspectives 8.3 Adjuvant Systemic Treatment in Cholangiocarcinoma 8.4 Systemic Treatment for Advanced or Unresectable Cholangiocarcinoma 8.4.1 Chemotherapy 8.4.2 Second-Line Chemotherapy 8.5 Conclusion References 9 Palliative Care in Cholangiocarcinoma 9.1 General Principles in Palliative Care 9.1.1 Definition of Palliative Care 9.1.2 Model of Care 9.1.3 Palliative Care Criteria 9.1.4 Assessment 9.1.5 Symptom Management 9.1.6 Pain 9.1.7 Dyspnea 9.1.8 Nausea and Vomiting 9.1.9 Communication 9.1.10 Bereavement 9.1.11 Summary 9.2 Palliative Biliary Drainage for Advance Stage Cholangiocarcinoma 9.2.1 Percutaneous Palliative Biliary Drainage 9.2.2 Palliative PTBD 9.2.3 Complication of Percutaneous Transhepatic Biliary Drainage 9.2.4 Hemorrhage 9.2.5 Pericatheter Leakage 9.2.6 Palliative PTBS 9.2.7 Planning and Preparation 9.2.8 Indications for PTBS 9.2.9 Contraindication for PTBS 9.2.10 Instruments and Procedures 9.2.11 Complications 9.2.12 Endoscopic Biliary Stenting 9.2.13 Type of Metallic Biliary Stent 9.2.14 Fully Covered Type 9.2.15 Partly Covered Type 9.2.16 Uncovered Type 9.2.17 Outcome of SEMS 9.2.18 Surgical Biloenteric Bypass 9.2.19 Operative Procedure 9.2.20 Right Sided Hepaticojejunostomy References 10 Digital Innovations (Isan Cohort) 10.1 Background 10.2 Overview 10.3 OV-CCA Module 10.4 Tele-Radiology 10.5 Pathology Database 10.6 Surgery Database 10.7 Palliative Care Database 10.8 Randomized Controlled Trial (RCT) Database References 11 RAW ATTITUDES: Socio-Cultures, Altered Landscapes, and Changing Perceptions of an Underestimated Disease 11.1 An Ecologically Embedded and Socially Entwined Life Cycle 11.2 An Underestimated and Neglected Parasite in World Public Health 11.3 Socio-Economic Dimensions of Disease 11.4 Developmental Landscapes and Anthropogenic Ecologies 11.4.1 Aquaculture and Irrigation 11.4.2 Dams and Reservoirs 11.4.3 Roads and Rivers: Migration and Mobility 11.5 Uneven Regional Knowledge About the Extent of Opisthorchis viverrini and Opisthorchiasis 11.6 Public Health Programs Tackling OV and CCA in Thailand 11.7 Raw Attitudes in Isan 11.8 Raw Attitudes in Lao PDR 11.9 Raw Attitudes in Vietnam 11.10 Raw Attitudes in Cambodia 11.11 Altering Attitudes and Public Health Approaches References 12 Community Awareness and Education: In the West and Southeast Asia 12.1 Southeast Asia—Background 12.2 The UK and Europe—Background 12.3 How Can the CCA Challenges in Southeast Asia and the West Be Overcome? 12.3.1 Raising Awareness and Understanding in Southeast Asia 12.4 Combatting Cholangiocarcinoma in the Lao People’s Democratic Republic 12.5 The Challenges Faced by Healthcare Professionals in Southeast Asia 12.6 The Challenges Faced by Cholangiocarcinoma Patients in Southeast Asia 12.7 Raising Awareness and Understanding in the West 12.8 The Challenges Faced by Healthcare Professionals in the West 12.9 The Challenges Faced by CCA Patients in the West 12.10 Molecular Profiling and Targeted Therapies 12.11 How Can the CCA Challenges Be Overcome in Southeast Asia and the West? 12.12 In Southeast Asia 12.13 In the West 12.14 National and International Bodies 12.15 Looking to the Future 12.16 In the West 12.17 Final Thoughts ... References 13 Synopsis