Cholangiocellular carcinoma (CCC) is a very aggressive
tumor, which remains highly resistant to current chemoradiation
therapies. Death is usually caused by the
tumor burden. However, biliary obstruction, which leads to
cholangitis and
liver failure, is also a cause of death. Therefore, relief of biliary obstruction is one of the key
palliative treatment options for patients with hilar or distal CCC. Radiologic or endoscopic insertions of
stents (
plastic or self-expanding
metal) are definite biliary drainage options. Whereas
stents alone can help achieve relief of
bile duct obstruction, endoscopic ablative interventions with
photodynamic therapy or
radiofrequency ablation are also useful in destroying intraluminal
tumor. Destroying the
tumor leads to an increase in the
luminal diameter of the obstructed bile duct, allowing for placement of more or larger diameter
stents, and thus improving bile flow. Besides decreasing morbidity associated with obstruction, ablative
therapies such as
photodynamic therapy have also been associated with improved survival in a sub-group of patients with CCC and should therefore be incorporated into the treatment algorithm of any center treating patients with CCC.