Eric A. Collisson, MD, associate professor, Department of Medicine, University of California, San Francisco Helen Diller Comprehensive Cancer Center, discusses the difficulty of diagnosing cholangiocarinoma.

It is difficult to diagnose patients with cholangiocarcinoma, states Collisson. Most oncologists and many clinicians are familiar with liver tumors that are detected radiographically. The correct assumption most of the time, says Collisson, is that it’s a metastasis. It can be difficult to rule out carcinoma from another source in the body that has traveled to the liver versus what is termed a "diagnosis of exclusion." Isolating the tumor’s origin from the biliary tract system is increasingly done by sophisticated pathology approaches.

The problem is that cells are quite infrequent and difficult to obtain. Pathologists are tasked with diagnosing the disease efficiently, while leaving adequate tissue for other analyses such as FGFR2. Collisson says this is a rationing strategy.

Videos

Dr. Collisson on the Difficulty of Diagnosing Cholangiocarcinoma

Eric A. Collisson, MD, associate professor, Department of Medicine, University of California, San Francisco Helen Diller Comprehensive Cancer Center, discusses the focus of clinical trial research and genetic testing in gastrointestinal (GI) cancers.

Physicians are learning that though the primary tumor can be easily accessed with an endoscope, the metastatic site isn’t always perfectly reflected. Clinical trials are now being designed to look at metastases more closely.

The role of germline genetics in pancreatic cancer and other GI malignancies is becoming increasingly clear. Physicians are using the data in breast and ovarian cancer to guide their search for germline and somatic defects in GI cancer.

To what depth every tumor should be examined and whether patients should undergo testing upfront, or after they’ve failed frontline treatment has yet to be determined. What’s clear is that physicians have the technology and a larger armamentarium of drugs to combat the disease than they did 2 years ago.

Eric A. Collisson, MD

Articles

Dr. Collisson on the Difficulty of Diagnosing Cholangiocarcinoma

Dr. Collisson Discusses Developments in Gastric Cancers