Diseases that are easily confused with bile duct cancer

Although bile duct cancer has some obvious symptoms, such as jaundice and unexplained abdominal pain, it cannot be diagnosed as bile duct cancer based on these symptoms alone. It is often confused with other diseases. The diagnosis should be supplemented with laboratory and imaging tests to avoid misdiagnosis and miss the best treatment period for the disease. Let's take a look at the diseases that are easily confused with bile duct cancer.

In general, bile duct cancer is easily confused with the following two major diseases, which require further identification and diagnosis with the help of relevant information and scientific examinations. The following is a detailed introduction:

1. Benign bile duct disease

(1) Benign bile duct tumors:

It is difficult to differentiate between benign and malignant bile duct tumors in medical history, physical examination and direct cholangiography, and generally relies on histological and cytological examinations. However, if metastatic lesions are found before surgery, they are definitely malignant.

(2) Common bile duct stones:

The patient has a long medical history, and most patients have a history of paroxysmal abdominal pain. Jaundice is also intermittent, with obvious symptom relief periods. Pain attacks are often accompanied by varying degrees of cholangitis symptoms, such as fever, chills, increased blood count, and signs of localized peritonitis. In choledochography, translucent shadows of stones and cup-shaped shadows can be seen, and the bile duct wall is smooth, but it is difficult to distinguish from polyp-type cholangiocarcinoma. Choledochoscopy is helpful for diagnosis.

(3) Mirrizzi syndrome:

Cholangiography can show compression of the right side of the common hepatic duct with smooth edges. Ultrasound can show stones incarcerated in the cystic duct. If the diagnosis is uncertain during surgery, bile duct histology can be performed.

(4) Benign biliary stricture:

It usually occurs after abdominal surgery, and a few occur after abdominal trauma. Biliary strictures can also be shown in choledochography, but their edges are smooth and symmetrical on both sides. If necessary, choledochoscopy can be used to obtain tissue specimens for identification.

(5) Primary sclerosing cholangitis:

It is more common in middle-aged people, more common in men than in women. Abdominal pain is mostly paroxysmal, rarely biliary colic. Jaundice is mostly intermittent and progressive. Laboratory tests show obstructive jaundice. Cholangiography often shows extensive chronic stenosis and stiffness of the bile duct, but there are also cases where the lesions are limited to part of the bile duct. This type is not easy to distinguish from bile duct cancer and can only be confirmed by naked eye findings and histological examination during laparotomy.

(6) Chronic pancreatitis:

This disease can also cause stenosis or occlusion of the intrapancreatic bile duct and jaundice, but the history is long and the jaundice is mild. In cholangiography, it can be seen that the stenosis of the diseased bile duct is symmetrical on both sides and the edges are smooth. Further pancreatic function tests, ERCP, CT and intraoperative biopsy are required for diagnosis.

(7) Capillary cholangiohepatitis:

This disease may also present with symptoms such as nausea, anorexia, jaundice, itchy skin, and clay-like stools, which can be easily confused with bile duct cancer. However, the differences are: no gallbladder enlargement, no biliary colic, increased urobilinogen in urine, abnormal liver function tests, and no bile duct dilatation on B-ultrasound. The diagnosis must rely on liver puncture biopsy.

2. Malignant diseases of the bile duct

(1) Pancreatic head cancer:

This disease is often accompanied by obstruction of the pancreatic duct, and ERCP images show pancreatic duct stenosis or occlusion. Ultrasound and CT images show a mass in the pancreatic head and a significant dilation of the pancreatic duct in the pancreatic body and tail. There is often a significant reduction or lack of pancreatic enzymes in the duodenal drainage fluid. Clinically, jaundice is more significant, and is often painless and progressive. When pain occurs, it is usually in the late stage.

(2) Papillary cancer:

Hypotonic duodenography can often show a filling defect on the left edge of the descending duodenum. Endoscopy can often directly visualize the tumor and perform histological examination.

(3) Gallbladder cancer:

When the disease invades the hilar bile duct or the upper bile duct, it is difficult to differentiate it from cholangiocarcinoma. However, B-ultrasound and CT scans can show consolidation or mass in the gallbladder, and selective arteriography can show ischemic tumor shadows in the gallbladder area.

(4) Liver cancer:

It is sometimes difficult to differentiate intrahepatic cholangiocarcinoma from liver cancer during cholangiography, but primary liver cancer often has a history of cirrhosis and a positive AFP test. Therefore, a comprehensive judgment and analysis based on medical history, AFP, B-ultrasound, CT, selective arteriography, etc. is required. Sometimes a histological examination of the resected specimen is required for a confirmed diagnosis.

(5) Duodenal cancer or sarcoma:

Sometimes, abnormal course, stenosis or even occlusion of the common bile duct may be seen in cholangiography. However, upper gastrointestinal barium meal can often show space-occupying images in the duodenum, and endoscopic examination can better confirm the diagnosis.

(6) Advanced gastric cancer:

When gastric cancer metastasizes to the lymph nodes, it may also cause bile duct obstruction, but upper gastrointestinal tract barium meal and endoscopic examination are sufficient to confirm the diagnosis.