Articles On Ayurved · Kaya Chikitsa · Nidan

CHOLANGIOCARCINOMA (CCC)

CHOLANGIOCARCINOMA (CCC)
CCC typically refers to mucin-producing adenocarcinomas that arise from the bile ducts. They are grouped by their anatomic site of origin as intrahepatic, hilar (central, ~65% of CCCs), and peripheral (or distal, ~30% of CCCs).
They arise on the basis of cirrhosis, excepting primary biliary cirrhosis.

Aetiology
Although most CCCs have no obvious cause, several predisposing factors have been identified, including primary sclerosing cholangitis, an autoimmune disease (10–20% of PSC patients), and liver fluke in Asians, especially Opisthorchis viverrini and Clonorchis sinensis.

CCC seems also to be associated with any cause of chronic biliary inflammation and injury, with alcoholic liver disease, choledocholithiasis, choledochal cysts (10%), and Caroli’s disease.

Clinical Features:
CCC most typically presents as painless jaundice, often with pruritus or weight loss, and
acholic stools.

Investigation:

Diagnosis is made by biopsy, percutaneously for peripheral liver lesions or, more commonly, via endoscopic retrograde cholangiopancreatography (ERCP) under direct vision for central lesions.

The tumors often stain positively for cytokeratins 7, 8, and 19 and negatively for cytokeratin 20.

However, histology alone cannot usually distinguish CCC from metastases from primary tumors of the colon or pancreas.

Serologic tumor markers appear to be nonspecific, but CEA, CA 19-9, and CA-125 are often elevated in CCC patients and are useful for following response to therapy.

Radiologic evaluation typically starts with ultrasound, which is useful in visualizing dilated
bile ducts, and then proceeds with either MRI or magnetic resonance cholangiopancreatography (MRCP) or helical CT scans.

Invasive ERCP is then needed to define the biliary tree and obtain a biopsy or is needed therapeutically to decompress an obstructed biliary tree with internal stent placement.

If that fails, then percutaneous biliary drainage will be needed, with the biliary drainage flowing into an external bag.

Central tumors often invade the porta hepatis, and locoregional lymph node involvement by tumor is frequent.

GALLBLADDER CANCER (GB Ca)
GB Ca has an even worse prognosis than CCC, with typical survival of ~6 months or less. Women are affected much more commonly than men (4:1), unlike in HCC or CCC, and GB Ca is more common than
CCC. Most patients have a history of gallstones, but very few patients with gallstones develop GB Ca (~0.2%). It presents similarly to CCC and is often diagnosed unexpectedly during gallstone or cholecystitis surgery.

Clinical Features:
Presentation is typically that of chronic cholecystitis,
Chronic right upper quadrant pain and
weight loss.

Useful but nonspecific serum markers include CEA and CA 19-9.
CT scans or MRCP typically reveal a gallbladder mass.

The mainstay of treatment is surgical, either simple or radical cholecystectomy for stages I or II disease, respectively.

CARCINOMA OF THE AMPULLA OF VATER
This tumor arises within 2 cm of the distal end of the common bile duct, and is mainly (90%) an adenocarcinoma. Locoregional lymph nodes are commonly involved (50%), and the liver is the most frequent
site for metastases.

Clinical Presentation:
Jaundice, and
many patients also have pruritus,
weight loss, and
epigastric pain.

Investigation:
Initial evaluation is performed with an abdominal ultrasound to assess vascular involvement, biliary dilatation, and liver lesions.
This is followed by a CT scan, or MRI and especially MRCP.
Adjuvant chemotherapy or radiotherapy has not been shown to be useful in enhancing survival. For metastatic tumors, chemotherapy is currently experimental.

Ayurveda can be better option in Cholangiocarcinoma (CCC), Carcinoma of the Ampulla of Vater and Gallbladder Cancer (Gb Ca). Following drugs may be used:

Lashuna, (Allium sativum) Garlic
Nimba, (Azadirachta indica), Neem tree
Sharpunkha, (Tephrosia purpurea)
Kumari, (Aloe barbadensis), Common Indian Aloe
Bhringaraj (Eclipta alba)

Ayurveda is better option as main line therapy or as complimentary therapy in various complications related to Cancer. Herbs mentioned above are just a bucket from the ocean. A good research in the field will help to improve the life of cancer patient without any economic burden.

Prof. Dr. Satyendra Narayan Ojha ,
MD (KC), Ph.D.
Director , Yashawant ayurveda college , Post graduate teaching and research center ,
Kodoli ,Panhala , Kolhapur..
drsnojha@rediffmail. com


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