Biliary tract cancer

Recent advances in the molecular biology and treatment of biliary tract cancer are highlighted in this review. Mutations in an oncogene (K-ras) and a tumor suppressor gene (p53) are increasingly reported in association with biliary tract cancer, and their presence may indicate a poor prognosis. The identification of a point mutation in cyclin-dependent kinase 4 inhibitor p1 6INK4 in vivo and in vitro suggests that biliary tract carcinogenesis is associated with the inactivation of important cell-cycle proteins. Several institutions not only in Japan but also in the Western hemisphere report the results of extended resections including hepatectomies in combination with local resections for proximal cholangiocarcinoma. In the selected group of patients curatively resected (negative margins), this appears to translate into improved median and long-term survivals. Likewise, complete resection of gallblader cancer without microscopic residual disease is associated with long median survival rates, even in advanced stages. Radiation therapy has been used in patients with positive margins as adjuvant treatment or as palliation of unresectable biliary tract carcinoma. A detailed review of several recent series reporting the results of radiotherapy in these two settings suggests that radiotherapy currently does not confer a definite improvement in survival.