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Cholangiocarcinoma can arise anywhere along the biliary system. Patients with biliary tract cancer (intrahepatic, peri-hilar, extra-hepatic, and gallbladder cancer) tend to have advanced disease at presentation, with a median survival of about 6–9 months from the time of diagnosis [1]. Surgery with clear histologic margins (R0 resection) in combination with appropriate lymph node dissection is the only chance of cure with published five-year survival rates of 24–40 % [2]. Curative surgical resection, however, is only feasible in a minority of patients [3], even in the setting of radical hepatic surgery [4, 5]. The management of patients with biliary tract cancer is complex and has been changing with the development of novel treatment alternatives. Furthermore, more aggressive surgical approaches have emerged over the past decade to treat patients previously considered to have unresectable disease, including portal vein embolization, combined hepatectomy with vascular resection, non-touch technique and, in highly selected patients, liver transplantation [6]. Minimal invasive surgery in hepato-pancreato-biliary diseases and neoadjuvant treatment is also among the last newly strategies added to the biliary tract cancer therapy. Indications, surgical selection, possible benefits, and limitations of each of these treatment alternatives will be discussed in the light of the most recent literature. [ABSTRACT FROM AUTHOR]

Standard endoscopic ultrasound (EUS) and intraductal ultrasonography (IDUS) are, with magnetic resonance, the best techniques currently available to image the extrahepatic bile ducts and the gallbladder. In this chapter, we review current knowledge about gallstone disease, bile duct strictures, and gallbladder lesions. In patients at high risk of having bile duct stones, endoscopic retrograde cholangio-pancreatography (ERCP) is the most cost-effective procedure, whereas EUS is indicated when the clinical index of suspicion for stones is low or intermediate (to spare costs and morbidity associated with ERCP). Sensitivity and specificity of EUS for the diagnosis of choledocholithiasis are close to 95%. In cases of unexplained acute pancreatitis, EUS provides a diagnosis in a majority of patients; in particular by detecting gallstone disease that had not been suspected at percutaneous ultrasonography. For the diagnosis of malignant vs. benign biliary strictures, the accuracy of EUS without fine needle aspiration (FNA) is not as high (80%), but EUS-FNA (in particular of lymph nodes) alters patient management in a -significant proportion of cases. IDUS is the best technique for assessing the longitudinal tumor extent as well as T (but not N) categories. IDUS may also assist in diagnosing malignant transformation in primary sclerosing cholangitis. Gallbladder polypoid lesions are frequent and can better be assessed by EUS than by percutaneous ultrasonography. EUS may be useful to examine lesions measuring 5–10 mm in diameter. Finally, the accuracy of EUS for staging gallbladder cancer is in the range of 80–90%; it is particularly useful to distinguish between T1 and T2 tumors because the therapeutic planning is markedly different between these two categories. [ABSTRACT FROM AUTHOR]

Chapter 19 of the book "Biliary Tract and Gallbladder Cancer: Diagnosis and Therapy" is presented. The chapter focuses on the effectiveness of three-dimensional conformal (3D-CRT) and intensity-modulated radiation therapy (IMRT) for biliary tract and gallbladder cancers. Researchers L. A. Dawson and colleagues found that liver could not tolerate higher radiation doses in 3D-CRT. Studies have shown the potential of IMRT at lower dose for biliary tract tumors without affecting the organs at risk (OAR).

Chapter 18 of the book "Biliary Tract and Gallbladder Cancer: Diagnosis and Therapy" is presented. The chapter explores the effectiveness and methods of radiation therapy for biliary tract and gallbladder cancers. It provides an overview on the tolerance of the hepatobiliary tree, liver and surrounding organs and structures to radiation therapy. The chapter also discusses the response of the bile duct and gallbladder tumors to radiation doses.

Chapter 23 of the book "Biliary Tract and Gallbladder Cancer: Diagnosis and Therapy" is presented. The chapter focuses on the factors to consider in conducting research on biliary tract and gallbladder cancers. It suggests extension of collaborative data sharing to institutional and international datasets aside from registries and federal programs to better identify risk factors and cohorts at risk. It recommends the creation of large-scale epidemiologic and clinical datasets, and preventive trials for stratification of risk factors.

Chapter 16 of the book "Biliary Tract and Gallbladder Cancer: Diagnosis and Therapy" is presented. The chapter discusses the etiology, pathology, staging, clinical features, evaluation and surgical and non-surgical management of gallbladder cancer. It is said that history of gallstone disease, obesity and multiparity are the main risk factors of gallbladder cancer. It notes that there is small chance of survival among patients who had recurrence of the disease at the incision site and bile spillage.

Chapter 22 of the book "Biliary Tract and Gallbladder Cancer: Diagnosis and Therapy" is presented. The chapter focuses on symptom management and palliation of biliary tract and gallbladder cancers. It explores the management of pain, duodenal obstruction and biliary obstruction in patients. Palliative methods available for such cancers are percutaneous drainage and endoprosthesis using plastic polyethylene and self-expandable metal stents.

Chapter 21 of the book "Biliary Tract and Gallbladder Cancer: Diagnosis and Therapy" is presented. The chapter explores the effectiveness, methods and complications of image-guided radiation therapy (IGRT) and stereotactic body radiation therapy (SBRT) for such cancers. SBRT are linked with hepatic toxicities and hemorrhage, fistula and stenosis of luminal gastrointestinal tissues. Breathing motion can be controlled in IGRT through abdominal pressure, shallow breathing, deep inspiration, breath holds and active breathing control.

Chapter 11 of the book "Biliary Tract and Gallbladder Cancer: Diagnosis and Therapy" is presented. This chapter deals with the use of computed tomography (CT) in the diagnosis and staging of gallbladder and biliary tract cancers. The epidemiology of gallbladder cancer and the differential diagnosis for this condition are discussed. The efficacy of cross-sectional imaging with multislice (MS)CT in the pre-operative assessment of gallbladder and cholangiocarcinoma is tackled.

Chapter 6 of the book "Biliary Tract and Gallbladder Cancer: Diagnosis and Therapy" is presented. This chapter discusses the pathologic staging system for gallbladder and biliary tract cancers. One of the most common staging system being used is the TNM system, in which the extent of tumor invasion, the lymph node status and the distance of metastasis are taken into consideration. The staging of gallbladder cancer, extrahepatic bile duct cancer and ampullary carcinoma are detailed.

Chapter 3 of the book "Biliary Tract and Gallbladder Cancer: Diagnosis and Therapy" is presented. The chapter discusses the histopathology and molecular pathogenesis of gallbladder cancer, which is considered a rare tumor in most countries. A definitive treatment for mucosal carcinoma and muscular carcinomas of the gallbladder is cholecystectomy. It associates age of the patients with dysplasia-gallbladder cancer progression.

Chapter 7 of the book "Biliary Tract and Gallbladder Cancer: Diagnosis and Therapy" is presented. This chapter deals with diagnostic imaging methods for gallbladder and biliary tract cancers. Such diagnostic imaging methods include magnetic resonance imaging (MRI), ultrasound (US), computed tomography (CT) and cholangiography. Other techniques include angiography, 2-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) and cholangioscopy.

Chapter 2 of the book "Biliary Tract and Gallbladder Cancer: Diagnosis and Therapy" is presented. The chapter discusses the role of growth factors and their receptors in gallbladder carcinogenesis. It associates the over-expression of epidermal growth factor receptor (EGFR) erbB2 with increased risk of gallbladder carcinomas (GBC) and cholangiocarcinomas. Aside from its role in normal growth and development, insulin-like growth factor 1 receptor (IGF-1R) may also cause tumor development and progression.

Chapter 1 of the book "Biliary Tract and Gallbladder Cancer: Diagnosis and Therapy" is presented. The chapter discusses the epidemiology of the cancer of the gallbladder and biliary tract. Majority of the patients who were diagnosed with biliary tract cancer present either locally advanced or distant metastatic disease. Reports associate primary tumors of the gallbladder with age and gender, with women having increased risk of developing this disease than men.

Information on treating carcinoma of the gall bladder by resection of liver and extrahepatic biliary tree taken from a chapter of the book "Atlas of Gastrointestinal Surgery," Volume 1, Second Edition, is presented. It is noted that gall bladder carcinoma is usually incurable and palliative care is given. Operative procedures are detailed.