Bile Duct Carcinoma (Cholangiocarcinoma): Incorrect

Tumors of the bile duct are not more common in patients with cholelithiasis. The average age at diagnosis is 60 years old although there is a wide range. Many of these patients have a history of sclerosing cholangitis or chronic parasitic infestation of the bile ducts. At presentation metastases are uncommon but the tumor has often grown into the portal vein or hepatic arteries. The patient usually presents with a gradual onset of jaundice or pruritus. Fever, chills, and biliary colic are usually absent. Anorexia and weight loss develop with time. Lab studies demonstrate a greatly elevated serum bilirubin (often - 15 mg/dL). Alkaline phosphatase is also elevated. A leukocytosis is not usually present. Ultrasound and CT scans will usually detect dilated intrahepatic bile ducts. Transhepatic cholangiogram and ERCP are also useful. The prognosis for cholangiocarcinoma is poor with a five year survival rate of 15%.

It is very unlikely that Mrs. Jones has a bile duct tumor. The acute nature of her symptoms argues against a chronic process such as a tumor. In addition her LFTs were normal and she had a moderate fever and leukocytosis which would be uncommon with a tumor.

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