Klatskin tumor
Meaning of Klatskin tumor: A tumor whose whole difficulty is its address: small, slow to declare itself, and sitting where the liver's plumbing converges.
Definition of Klatskin tumor
A Klatskin tumor is a bile duct cancer arising at the hilum of the liver, the point where the right and left hepatic ducts join to form the common hepatic duct. It grows from the cells lining those ducts. Because a tumor there blocks drainage from both halves of the liver, jaundice appears while the growth is still small.
Where does it fit among bile duct cancers?
| Group | Where it arises | Relative frequency |
|---|---|---|
| Intrahepatic | Ducts running inside the liver | The smallest group |
| Perihilar, the Klatskin type | At the junction of the right and left ducts | The largest group |
| Distal | The lower duct, near the pancreas | Intermediate |
All three are forms of cholangiocarcinoma and share a cell of origin, but little else. Position decides the symptoms, the operation and the outlook, which is why the perihilar group carries an eponym of its own. The duct junction lies just outside the liver rather than deep within it, so this tumor is usually counted with the group outside the liver even though liver tissue begins millimeters away.
How does it present?
Painlessly at first, which is much of the problem. Yellowing of the skin and eyes, dark urine and pale stools appear as bile backs up, often preceded by itching. Weight loss and a dull ache follow. There is no lump to feel and no early warning, and by the time drainage is blocked enough to turn the skin yellow the tumor has commonly grown into the vessels running beside the ducts. Long standing inflammation of the bile ducts, certain liver fluke infections and duct cysts present from birth all raise the risk.
Why is it so difficult to treat?
Location again. The portal vein and the hepatic artery run within millimeters of the duct junction, so even slight spread can involve the blood supply of the liver. Removing the tumor usually means taking half the liver along with the duct junction, a large operation in someone already jaundiced and undernourished. The tumor also creeps lengthwise along the duct wall, so its true extent exceeds what a scan shows, and tumor is often found at the cut edges after an apparently complete removal. Classification schemes grade how far it has reached into the branch ducts on each side, and that grade decides which operation, if any, is possible.
Also known as
Used in a sentence
Imaging described a perihilar mass consistent with a Klatskin tumor.
Good to know
The tumor spreads lengthwise along the duct wall beyond what imaging shows, which is why tumor is frequently found at the cut edges after an operation that appeared complete.