From the Guidelines
Intrahepatic cholangiocarcinoma (iCCA) management should prioritize surgical resection for resectable disease, with consideration of adjuvant therapy, especially for patients with N1 disease, as recommended by the most recent guidelines 1.
Diagnosis and Staging
Diagnosis of iCCA is crucial and often involves imaging and biopsy to differentiate it from other liver cancers, as imaging alone can lead to false-positive diagnoses 1. Staging is critical for determining the best course of treatment, with the TNM staging system being commonly used to classify the disease into stages I through IV 1.
Treatment Approach
- Surgical Resection: For patients with resectable iCCA, surgical resection is the primary treatment option, aiming for R0 resection to remove all disease with negative microscopic margins 1. The decision to operate should consider the patient's overall health, liver function, and the potential for achieving an R0 resection.
- Adjuvant Therapy: For patients undergoing resection, especially those with N1 disease, adjuvant therapy should be strongly considered to improve outcomes 1. The choice of adjuvant therapy may include chemotherapy, such as gemcitabine and cisplatin, or participation in clinical trials evaluating new treatments.
- Systemic and Loco-regional Therapies: For patients with unresectable disease or those who are not candidates for surgery, systemic therapies like gemcitabine and cisplatin, or loco-regional therapies such as radiofrequency ablation (RFA) or transarterial chemoembolization (TACE), may be considered 1.
Prognosis and Follow-Up
The prognosis for iCCA patients varies significantly based on the stage at diagnosis and the presence of lymph node metastasis, vascular invasion, or intrahepatic metastasis 1. Regular follow-up is essential for monitoring recurrence and progression, with a focus on symptoms that could indicate disease progression, such as abdominal pain, weight loss, or jaundice.
Multidisciplinary Approach
Given the complexity of iCCA management, a multidisciplinary team approach is recommended, involving hepatobiliary surgeons, medical oncologists, radiologists, and pathologists to tailor treatment plans to individual patient needs and to discuss the latest evidence and guidelines, such as those from the EASL-ILCA 1 and NCCN 1.
From the Research
Cancer Imaging and Treatment
- Cancer poses a major health problem due to cancer-related deaths and treatment toxicities 2
- Noninvasive techniques such as computed tomography (CT), magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT) and positron emission computed tomography (PET) are used in cancer diagnosis 2
- Conventional cancer treatment includes chemotherapy, radiotherapy, and surgery, but new approaches such as nanosized drug delivery systems and combined treatment protocols are being investigated 2, 3
Chemoradiotherapy in Cancer Treatment
- Chemoradiotherapy (CRT) refers to the combined administration of chemotherapy and radiotherapy as an anticancer treatment 4
- CRT has become an established treatment for locally advanced solid tumours and offers notable patient survival benefits and local disease control without significant long-term toxicities 4
- The combination of CRT and immunotherapy has emerged as an exciting field of research with potential for significant clinical benefit 4
New Approaches in Cancer Treatment
- Significant advances are being made in cancer treatment, including stem cell therapy, targeted therapy, ablation therapy, nanoparticles, natural antioxidants, and ferroptosis-based therapy 3
- Current methods in oncology focus on the development of safe and efficient cancer nanomedicines 3
- Targeted therapy has breakthrough potential in inhibiting the growth and spread of specific cancer cells, causing less damage to healthy cells 3
Diagnostic Techniques
- MRI-targeted biopsy can reduce the misclassification of prostate cancer in men with MRI-visible lesions 5
- Combined biopsy, including both MRI-targeted and systematic biopsy, can lead to more accurate cancer detection and grading 5
- Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are rapidly moving from detection and size measurement of lesions to quantitative assessment of metabolic processes and cellular and molecular interactions 6