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Journal für Gastroenterologische und Hepatologische Erkrankungen

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26.01.2024 | Originalien

Progress im Management des cholangiozellulären Karzinoms

verfasst von: Dr. Dajana Bolf, Katja Schmitz, Markus Peck-Radosavljevic

Erschienen in: Journal für Gastroenterologische und Hepatologische Erkrankungen | Ausgabe 1/2024

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Zusammenfassung

Leberkarzinome, insbesondere cholangiozelluläre Karzinome (CCA), stellen eine signifikante Krebstodesursache in Österreich dar, wobei CCA in Gallenblasen- und Gallengangkarzinome unterteilt werden, Letztere weiter in intrahepatische (iCCA) und extrahepatische (eCCA) Typen. Risikofaktoren umfassen Hepatitisinfektionen, Leberzirrhose, Gallengangentzündungen und Lebensstilfaktoren wie Diabetes, Fettleber sowie Nikotin- und Alkoholkonsum. Symptome, oft unspezifisch und erst im fortgeschrittenen Stadium auftretend, beinhalten Gewichtsverlust, Schwäche, Unwohlsein und Unterleibsschmerzen. Beim extrahepatischen CCA sind Cholestase, Ikterus, dunkler Urin, Pruritus und heller Stuhl frühe Anzeichen. Für die Diagnose werden Tumormarker wie das Carbohydrat-Antigen 19-9 (CA 19‑9), karzinoembryonales Antigen (CEA) und Alpha-Fetoprotein (AFP) verwendet, wobei CA 19‑9 und CEA bei CCA erhöht sein können. Bildgebende Verfahren wie Computertomographie, Magnetresonanztomographie, Endosonographie und endoskopische retrograde Cholangiopankreatikographie (ERCP) spielen eine zentrale Rolle in Diagnose und Staging. Histopathologisch werden CCA als Adenokarzinome klassifiziert, unterteilt in „Small-Duct-“ und „Large-Duct-Typen“, wobei die Immunhistochemie zur Differenzierung eingesetzt wird. Eine systematische Bestimmung behandelbarer Mutationen ist für die Therapiewahl essenziell. Die Behandlung hängt vom Tumorstadium ab. Bei lokal begrenzten Tumoren ist eine Operation erste Wahl, unterstützt durch präoperative Chemotherapie in bestimmten Fällen. Fortgeschrittene Tumoren erfordern systemische Therapien wie Gemcitabin und Cisplatin oder molekularbiologisch zielgerichtete Therapien, abhängig von spezifischen Mutationen. Immuntherapien gewinnen ebenfalls an Bedeutung. Die Behandlung fortgeschrittener Karzinome mit hoher Mikrosatelliteninstabilität beinhaltet oft Pembrolizumab. Der Fortschritt in molekularbiologisch fundierten Therapien und Immuntherapie verspricht verbesserte Behandlungsoptionen für CCA-Patienten in der Zukunft.

Vorheriger Artikel Editorial

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Titel: Progress im Management des cholangiozellulären Karzinoms
verfasst von: Dr. Dajana Bolf
Katja Schmitz
Markus Peck-Radosavljevic
Publikationsdatum: 26.01.2024
Verlag: Springer Vienna
Erschienen in: Journal für Gastroenterologische und Hepatologische Erkrankungen / Ausgabe 1/2024
Print ISSN: 1728-6263
Elektronische ISSN: 1728-6271
DOI: https://doi.org/10.1007/s41971-023-00184-x

Springer Medizin Österreich

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