Review Article

An update on the management of intrahepatic cholangiocarcinoma

Ka Wing Ma, Tan To Cheung


Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer. Together with klaskin tumour and cholangiocarcinoma of extrahepatic bile duct, it is one of the less prevalent subtypes. Pathologically, it can be classified as mass forming, peri-ductal infiltrative and intra-ductal growth. Since most ICC develops de novo and originates from the periphery of the biliary system, most patients present at a relative late stage of the disease. There is no specific tumour marker for diagnosis, and cross-sectional imaging remains the most informative diagnostic tool. Fluorodeoxyglucose (FDG)-PET scan is asensitive in picking up hypermetabolic foci and able to alter treatment plan in case of the presence of bilobar or extra-hepatic tumour. AJCC 7th edition remains the most frequently used staging system with validated discriminatory and prognostic ability. Surgical remains the only hope of cure provided that R0 resection could be achieved. Margin width tends to influence survival of patients with solitary tumour and node negative disease. The high recurrence rate and poor long-term outcome make liver transplantation an unpopular option for ICC treatment. Non-surgical treatments are mainly reserved for inoperable ICC, treatment outcomes are generally poor with overall survival (OS) depends on individual treatment response. Future studies on newer chemotherapeutic combination and molecular targeted regime are eagerly awaited.