Anatomical classification and mode of spread

Tumours of the bile duct can develop within the head of the pancreas (lower third tumours), in the hepatoduodenal ligament (middle third tumours), or at the level of the hepatic hilum, defined by the portal bifurcation, where the ducts converge into the right and left hepatic duct and into the main hepatic duct. Hilar cholangio-carcinomas (Klatskin's tumours) account for more than half in most series.

Cholangiocarcinomas, especially of the sclerosing and nodular type, infiltrate along the walls of the ducts and the perineural tissue before obstructing the lumen. Metastases to the lymph nodes are seen in 13-30% of patients undergoing surgery. Direct duodenal invasion and peritoneal carcinomatosis occur late.

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